New cat with chronic diarrhea (6 weeks and counting)

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tinytangerine

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mentat mentat massive thank you for the thorough post. I am learning a lot and it has been such a huge boon to me that all of you here are willing to put time into equipping me to advocate for my kitty's health. Unfortunately I can't simply put him back on the pred, since we ran out his course (which is why we have none now - vet said he didn't need to continue it). He was on 2.5 mg/day when we stopped, which seemed to be managing his symptoms well. To get more we'd need to get the vet to agree he needs it and prescribe it.

Food-wise, he will pretty much eat anything. For now (and for the past 6 weeks at this point) he has been on the Royal Canin hydrolyzed protein dry food. I know there's a lot wrong with it, but our vet feels strongly that he has a dietary allergy and that this will help confirm/identify it. They want him on it for 8 - 12 weeks. We wet the kibble (enough that he has to drink the water before he can eat) and serve across a large number of small meals throughout the day. So far he has been urinating at normal cadence/normal amounts but I am definitely worried about dehydration. We don't have anything at home to manage that as vet does not think it is an issue.

He had a standard blood panel run about a month ago and all his values were fine as per vet. I am not sure what is typically included in these panels - we asked to see the results but they seemed hesitant and at the time I did not push for it. She mentioned he had 'slightly elevated' globulin but that it was not far out of range and was likely related to whatever was causing the inflammation. The pred was initially given simply to control itch (as he was scratching patches of fur off). Essentially she is arguing that it is simply a combo of worms and allergies, and that the reason the loose stool reappeared was related to being close to the dewormer cycle (e.g., worms had returned and were impacting him again) rather than the pred. I'll call tomorrow and see if I can discuss otherwise....honestly, it's a bit exhausting and embarrassing to keep calling, feeling like I am the 'girl who cried wolf', but I do feel like our vet may be missing some clear signs because she has a diagnosis in mind. I also feel like because he is mostly having issues with loose stool rather than severe diarrhea (e.g. he is not using the litter box more than 2x/day) she is still thinking allergies.

Thank you so much again <3.
 

mentat

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mentat mentat massive thank you for the thorough post. I am learning a lot and it has been such a huge boon to me that all of you here are willing to put time into equipping me to advocate for my kitty's health. Unfortunately I can't simply put him back on the pred, since we ran out his course (which is why we have none now - vet said he didn't need to continue it). He was on 2.5 mg/day when we stopped, which seemed to be managing his symptoms well. To get more we'd need to get the vet to agree he needs it and prescribe it.

Food-wise, he will pretty much eat anything. For now (and for the past 6 weeks at this point) he has been on the Royal Canin hydrolyzed protein dry food. I know there's a lot wrong with it, but our vet feels strongly that he has a dietary allergy and that this will help confirm/identify it. They want him on it for 8 - 12 weeks. We wet the kibble (enough that he has to drink the water before he can eat) and serve across a large number of small meals throughout the day. So far he has been urinating at normal cadence/normal amounts but I am definitely worried about dehydration. We don't have anything at home to manage that as vet does not think it is an issue.

He had a standard blood panel run about a month ago and all his values were fine as per vet. I am not sure what is typically included in these panels - we asked to see the results but they seemed hesitant and at the time I did not push for it. She mentioned he had 'slightly elevated' globulin but that it was not far out of range and was likely related to whatever was causing the inflammation. The pred was initially given simply to control itch (as he was scratching patches of fur off). Essentially she is arguing that it is simply a combo of worms and allergies, and that the reason the loose stool reappeared was related to being close to the dewormer cycle (e.g., worms had returned and were impacting him again) rather than the pred. I'll call tomorrow and see if I can discuss otherwise....honestly, it's a bit exhausting and embarrassing to keep calling, feeling like I am the 'girl who cried wolf', but I do feel like our vet may be missing some clear signs because she has a diagnosis in mind. I also feel like because he is mostly having issues with loose stool rather than severe diarrhea (e.g. he is not using the litter box more than 2x/day) she is still thinking allergies.

Thank you so much again <3.
I know the feeling. I was a young woman some professionals had to learn from, persistent, not brand new, but assumed to be.

Hydrolyzed diets are wonderful, amazing tools we are fortunate to have in our arsenal now. Ignore whomever is "disbelieving" in them. Thousands of dogs, cats, and exotics benefit from them every day. My autoimmune vasculitis dog and many many patients and fosters would have a terrible quality of life or be deceased off hydrolyzed protein diet. Their singular experience with a handful of cats many here presume and assume allergies and diagnose themselves does not correlate with the diagnostics and assessments and plans for treatment you've vested in for your baby.

I can only encourage you to advocate for your own stress while managing a medical needs kiddo and advocate for treatments, for listening, for effective alleviation of symptoms and the well-being of your tiny tot. Consider an internal medicine or feline specialty medicine phone consult with video and emailed plan, to get a doctor to review your kitty's history and recommend immunosuppression and/or anti-inflammatory treatment for colitis secondary to primary disease process.

Channel us, our strength and determination en masse, helping you persevere, search, advocate, and achieve excellent care and management of your special feline. You got this! Ask away. Do you know how to look up internists and feline specialists boarded and check for telemedicine cobsults for new patients? I can help you find resources to get the treatments needed.
 

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Regarding your vet's synopsis of "just worms and allergies." Parasites are nasty nasty mothatruckas. They destroy intestinal villi, suck away blood when attach their oral cavity to intestinal wall lining, stealing nutrients. Tapes and other flatworms do not attach to the tract like this, but they do thrive on stealing nutrients from the food pets are digesting, and multiply exponentially, and migrate to many other systems beyond GI in the body. Tapeworms are rarely identified on fecal tests in hospital as their eggs lyse outside the host and eggs/ova are how most intestinal parasitic worms are identified and treated in vet med. "Just Worms" causes severe gastritis, enteritis, colitis, anemia, and low blood values related to the nutrition they steal intra-GI. Knowing the stool immediately was less solid upon cold-turkey stopping steroids (never should stop at daily dosing suddenly, very hard on body's adrenal glands, natural release returning of cortisol production, and feline pancreas/liver), inflammation immediately increased off the prednisolone.

I am not happy to read they were bothered or offended when you asked for labwork results. My vets all send links in email summaries of the visit as standard procedure, no request needed, either pdf's attached or link to view the radiograph or labwork. Vet hospitals are overworked currently, with understaffing, and some understanding and patience is warranted. It's sounds like you've already been patient. Time to emphasize you need them to help you help your cat. You know their time and attention is limited. Thus, you want to review and discuss the diagnostics and plan at length with your cat's family and friends, to help do what is best for your cat. If hearing an owner wanting to best by one of their patients does not motivate vet staff to give you easy access to his history and record, you are not at the right vet hospital and need a more supportive vet care community working with you and your cat.
 
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tinytangerine

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mentat mentat - I cannot thank you enough for your kindness and support in helping me feel equipped to advocate for my kitty.

Your posts helped me so much when I gave them a call back. I ended up speaking with the practice owner as the vet we had been seeing is off until Monday. She heard me out and agreed that he should go back on pred right away to get his stool back to normal, and then we could work on tapering the dose while re-testing for worms in a couple weeks (he had his last round of dewormer this past Monday) and monitoring diet. He got his first does of pred this afternoon. She also agreed to send over the lab results via email and did not push back on me. I think that this practice is to some extent trying to 'protect' patients from trying to interpret results themselves.

It is comforting (in some ways) to know that worms can be serious, and we should insist on making sure he is clear of them. So much of the messaging publicly seems to treat them like they are not a big deal, which felt counter to the symptoms we were seeing (if they are a major component).

Given that he has been on the hydrolyzed diet for 6 wks and it is not appearing to make a difference (e.g. as soon as he is off the pred, his stools go back to very loose and more frequent), she suggested we consider trying another diet, specifically the venison/rice Royal Canin Sensitivity VR while he is on the pred and see if we can wean him slowly off without issue in another 4 - 6 wks (tapering over time, starting at 5mg/day --> 2.5 mg/day --> 2.5mg EOD while keeping him on the new diet). This vet said that she does not suspect IBD or lymphoma at this time because of his age (we think appx 2), and believes it's a mixture of allergies and worms. We may do the PCR worm test again, though it's expensive and we didn't find anything the first time, so we'll have to think on it.

I've never been exposed to the world of internists or feline specialists - however, I am in Canada (not sure if your resources are more stateside?). It would be amazing if you could share some reading I could do on how to navigate that space and get in touch with the right people for a second opinion or more thoughts on what we should be looking for.

I can't thank you enough <3.
 
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tinytangerine

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Small update - he's been back on pred for three days now and it's already made a HUGE difference. Day 1 he still had runny stools - day 2, half was formed and half was runny - and today he had an 80-85% formed, segmented stool with some smooth/wetter at the end. I know it's the pred that is helping to control symptoms, and he is a young cat and pred forever isn't necessarily a good solution - but does it ever feel good to see the improvement even short-term and know he is feeling a bit better. His itching has also stopped, which I am grateful for, since he had started to scratch off some of the fur around his poor ears again.

Plan now is to transition him slowly onto a new novel protein wet diet, since after 8 wks the hydrolyzed diet still wasn't taking well, and taper pred very slowly as we go to make sure he stays stable with his stool. I am waiting on his blood test results for my records and still considering whether I should be reaching out to some kind of feline specialist for a second opinion on long-term plans/outlook and potential approaches to care.
 

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ACVIM, American College of Veterinary Internal Medicine, with specific certifications in feline medicine or other, such as neurology, oncology, etc. These are US and Canada board certifications. U of Guelph has some of the best ones around! I love Dr. Scott Weese especially, while the zoonotic disease department keeps us all current on SARS-CoV-2 crossing species again and again.

When, I search for Ontario, these are the results, including US DACVIMs proximal to Ontario, and Canadian DACVIMs, also.

American Association of Feline Practitioners has a Cat Friendly Clinic search tool here. Many vets are listed as AAFP Cat Friendly Gold Clinic in Canada.
 

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Glad to hear there's been tiny improvements while on the pred, but agree that probably can't be a long-term solution.

I'm very curious to see if changing to a novel protein helps.

As I think I mentioned upthread, even though normally the recommendation is to slowly transition to a new food, we switched Ruby to her hypoallergenic duck canned food all at once, and her stools literally improved overnight. However, Ruby was never officially diagnosed with IBD, so it might be just an intolerance to chicken that she has, along with a sensitive system.

About a feline specialist, if things don't improve with the food change, I think I would consider it, as they might have other treatment suggestions.

Good luck. :redheartpump:
 

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rubysmama rubysmama Seconded. Mine transition immediately to Ultamino, or other HP, or novel protein RX, or Raw nutritionist formulated diet when all else fails, IMMEDIATE relief! WoOT! PS, my favorite Ruby was a flyball papillon. What a minx! Your red tabby girl is rare, and Ruby is very apropos
 
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tinytangerine

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mentat mentat - massive thanks for all the resources! I am within driving distance (a long drive, but still) of UofG, so I feel silly for not thinking of them. I guess I assumed they would not see public cases, but that feels silly since obviously they are an operating vet hospital. I will keep them in mind if/when it feels necessary/appropriate to escalate the issue.

Kitty has been transitioning over the past week (shipping took forever, so I ordered lots) to Royal Canin Feline Sensitivity VR Canned Cat Food (Venison is the protein). He is still in transition right now getting 3/4s of his calories from the wet and 1/4 from the hydrolyzed protein dry (will move to full wet starting tomorrow). No idea if it is just a coincidence or due to the pred kicking in, but his stools improved dramatically as soon as we started transitioning him on to the wet (even with just 1/4th wet 3/4s dry). It's been a week now and he has consistently had very normal stools, segmented and firm but not hard or dry, no straining at the box, zero soft stools and zero gas. He is still doing some lip-licking and exaggerated swallowing, but I am wondering if that may be only somewhat related or simply prolonged stomach upset from having GI issues for so long. Once he is fully switched on to the wet we will try moving to EOD pred (2.5 mg) for a few more weeks, and then hopefully fully off as per vet instructions. Is that gradual enough tapering?

Again - can't thank everyone here enough for your support and time - I felt totally alone but now feel much more armed with knowledge and an understanding of the right questions to ask.
 

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mentat mentat - massive thanks for all the resources! I am within driving distance (a long drive, but still) of UofG, so I feel silly for not thinking of them. I guess I assumed they would not see public cases, but that feels silly since obviously they are an operating vet hospital. I will keep them in mind if/when it feels necessary/appropriate to escalate the issue.

Kitty has been transitioning over the past week (shipping took forever, so I ordered lots) to Royal Canin Feline Sensitivity VR Canned Cat Food (Venison is the protein). He is still in transition right now getting 3/4s of his calories from the wet and 1/4 from the hydrolyzed protein dry (will move to full wet starting tomorrow). No idea if it is just a coincidence or due to the pred kicking in, but his stools improved dramatically as soon as we started transitioning him on to the wet (even with just 1/4th wet 3/4s dry). It's been a week now and he has consistently had very normal stools, segmented and firm but not hard or dry, no straining at the box, zero soft stools and zero gas. He is still doing some lip-licking and exaggerated swallowing, but I am wondering if that may be only somewhat related or simply prolonged stomach upset from having GI issues for so long. Once he is fully switched on to the wet we will try moving to EOD pred (2.5 mg) for a few more weeks, and then hopefully fully off as per vet instructions. Is that gradual enough tapering?

Again - can't thank everyone here enough for your support and time - I felt totally alone but now feel much more armed with knowledge and an understanding of the right questions to ask.
On any Cerenia? Prolonged use is safe and effective in cats, from vet only, at 1-2mg/kg by mouth once daily. It helps with nausea, vomiting, visceral abdominal pain, respiratory secretions, so many benefits!
 
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tinytangerine

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No, no meds right now other than the pred. It is great to know there is something effective with no long-term impacts - I will ask the vet. He has never actually vomited, so I think the lip-licking has been a bit blown off as something that should just go away when we get him on the right food. Thanks for the info!
 
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tinytangerine

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Final follow-up for this issue, for anyone in the future who has a similar problem.

Our kitty has now been on Royal Canin Feline Sensitivity VR Canned Cat Food (Venison) for just over eight weeks. He's had solid normal stools since the first week or so. At this point he has been almost totally tapered off of the pred (he gets 1.25mg, i.e. a quarter pill, every other day). It seems like this has totally dealt with his GI issues (at least for now, fingers crossed!) and he will be on the very low dose of pred for a decent while yet - vet says at that dosage there's very little risk of side effects. So in his case - looks like it was various food sensitivities and finding one that played well + the pred to deal with the initial flare-up has gone a long way to getting him on track.
 

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Great news - I was thinking of IBD reading through this. Sounds like you won't need to worry about it, but as a FYI, I had a foster cat with IBD who almost died a few times from it and who had diarrhea every day for a year. Tried all the vet-recommended foots etc. In one flare I was desperate and read about raw - she didn't want it, but I made some little balls of raw hamburger and popped them in. The next day she had normal bowel movements. I transitioned her to grain-free kibble and for the rest of her life 3 or 4 years) she never had diarrhea again or a IBD flare.
 

rubysmama

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That's wonderful news T tinytangerine . :woohoo:

You must be so happy. And, of course, kitty must feel so much better without the discomfort of digestive issues.

Thanks for the update
 
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