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- May 28, 2022
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Hi everyone,
I had posted earlier about my cat Neko's difficulty in recovering from his PU surgery at the end of April - we've been experiencing chronic loose stools since (after antibiotics/change in food - he's back on his old food) with some intermittent vomiting that never seemed to resolve, then had vomiting and inappetence that led to multiple vet trips (lots of antibiotic prescriptions that he was on short-term that didn't help), and then a special trip to the internist, where it looked like an IBD flare-up but possibly lymphoma. We are currently treating with KittyBiome Gut Restore supplements, probiotics (Fortiflora because he likes the taste, or I think he still does, and KittyBiome S. boulardii + FOS Powder), an increase in prednisolone (2.5mg AM and 5mg PM), and amitriptyline (5mg). He's also on Cerenia (16mg) and gets potassium citrate granules with cranberry in his food.
Fortunately, Neko's stools have gotten much better, almost normal (but smellier than they were normally), and part of me is concerned that it's a happy side effect of the amitriptyline, which can cause constipation. He's been eating his food (with little enthusiasm, but still eating), drinking, but is very subdued and very tired. He doesn't talk to us anymore, rarely purrs when he's pet, doesn't wake us (me) up for breakfast, and doesn't roll over so we can pet his belly. He has such a big personality that we just haven't seen at all in over a week.
And now, we've received the results of Neko's GI Panel and Fecal PCR. I don't have the paperwork with specific numbers, only what his vet told me, which is:
To add to that,
I've emailed the internist with all these updates (naturally Neko hasn't wanted to eat today after I said he was eating well), but there's just so much information and so much going on I'm feeling overwhelmed. A lot of it isn't even definitive right now. Our regular vet doesn't think things have progressed to lymphoma, and I'm not really sure which of all these issues needs to be addressed first, if he should go back on Metronidazole, if it's the amitriptyline causing his personality issues/clearing up his diarrhea, and we haven't even gotten to things like switching him to a wet food or urinary diet or addressing his arthritis. He had some soft stool prior to his PU surgery, which I was going to address at his annual check-up, but we never made it that far. Was it maybe pancreatitis from the beginning causing his issues? The initial ultrasound didn't show anything out of the ordinary and the ultrasound for last week weirdly didn't address the pancreas at all (Is that weird? It seems weird to me.). We didn't do the specific GI panel back in April, though. The internist also doesn't seem to think that he was fully blocked at the time of his surgery although he couldn't be expressed.
I know a lot of you have experience with one or more of these issues, so I'm appreciative for any advice you can offer. Is there something else I can be doing to keep Neko comfortable? I did ask about giving him pain medication (he seems to have some discomfort but not outright pain), he's just on so much other medication/supplements right now it feels like a really delicate balance and I don't want to without explicit vet permission. And to be honest it feels like everything I tried to do to mitigate any issues from his surgery (after a very unpleasant cystotomy experience last year) only made things worse and everything I do now just doesn't seem to be helping. We've seen some improvement lately at the cost of other things but I'm constantly worried about him and if he'll ever get back to his old normal, or something approximating it. Maybe I'm just looking for words of comfort that he'll be okay or that at least we're doing something right for him.
Thank you all! I appreciate any input you all have. Hope you and your kitties are doing well.
I had posted earlier about my cat Neko's difficulty in recovering from his PU surgery at the end of April - we've been experiencing chronic loose stools since (after antibiotics/change in food - he's back on his old food) with some intermittent vomiting that never seemed to resolve, then had vomiting and inappetence that led to multiple vet trips (lots of antibiotic prescriptions that he was on short-term that didn't help), and then a special trip to the internist, where it looked like an IBD flare-up but possibly lymphoma. We are currently treating with KittyBiome Gut Restore supplements, probiotics (Fortiflora because he likes the taste, or I think he still does, and KittyBiome S. boulardii + FOS Powder), an increase in prednisolone (2.5mg AM and 5mg PM), and amitriptyline (5mg). He's also on Cerenia (16mg) and gets potassium citrate granules with cranberry in his food.
Fortunately, Neko's stools have gotten much better, almost normal (but smellier than they were normally), and part of me is concerned that it's a happy side effect of the amitriptyline, which can cause constipation. He's been eating his food (with little enthusiasm, but still eating), drinking, but is very subdued and very tired. He doesn't talk to us anymore, rarely purrs when he's pet, doesn't wake us (me) up for breakfast, and doesn't roll over so we can pet his belly. He has such a big personality that we just haven't seen at all in over a week.
And now, we've received the results of Neko's GI Panel and Fecal PCR. I don't have the paperwork with specific numbers, only what his vet told me, which is:
So it looks like chronic pancreatitis is possibly on the table now, too, which I've seen can also cause diarrhea/vomiting/inappetence/lethargy (like so many other things).He had a very mild elevation in his pancreatic specific lipase (indicating pancreatitis, which would most likely be chronic in his case). This is certainly not surprising but the lab also notes that it is not definitive and instead is open to interpretation. The lab's recommendation is to recheck it two weeks later. I almost expect a little pancreatitis with him. There is this thing called Triaditis in cats. IBD and pancreatitis (along with cholangitis) are the components. Cholangitis seems unlikely since that was mentioned with his very recent ultrasound. They did not see his pancreas on ultrasound so we cannot use that to rule in/rule out pancreatitis.
To add to that,
So we might possibly have a clostridium infection too.The Fecal PCR panel came back negative for everything except Clostridium difficile (which was positive). The test looks for a specific protein but does not check for the toxin produced by the bacteria. So this is a situation of exposure confirmed, but not necessarily an active infection (or cause/contributor of cause to his GI signs). Metronidazole is the drug of choice, at the higher dose that I prescribed more recently. For Metronidazole-resistant ones, we could try the alternative drug (Vancomycin) to see if that helps. I would only try the other drug if diarrhea returned.
I've emailed the internist with all these updates (naturally Neko hasn't wanted to eat today after I said he was eating well), but there's just so much information and so much going on I'm feeling overwhelmed. A lot of it isn't even definitive right now. Our regular vet doesn't think things have progressed to lymphoma, and I'm not really sure which of all these issues needs to be addressed first, if he should go back on Metronidazole, if it's the amitriptyline causing his personality issues/clearing up his diarrhea, and we haven't even gotten to things like switching him to a wet food or urinary diet or addressing his arthritis. He had some soft stool prior to his PU surgery, which I was going to address at his annual check-up, but we never made it that far. Was it maybe pancreatitis from the beginning causing his issues? The initial ultrasound didn't show anything out of the ordinary and the ultrasound for last week weirdly didn't address the pancreas at all (Is that weird? It seems weird to me.). We didn't do the specific GI panel back in April, though. The internist also doesn't seem to think that he was fully blocked at the time of his surgery although he couldn't be expressed.
I know a lot of you have experience with one or more of these issues, so I'm appreciative for any advice you can offer. Is there something else I can be doing to keep Neko comfortable? I did ask about giving him pain medication (he seems to have some discomfort but not outright pain), he's just on so much other medication/supplements right now it feels like a really delicate balance and I don't want to without explicit vet permission. And to be honest it feels like everything I tried to do to mitigate any issues from his surgery (after a very unpleasant cystotomy experience last year) only made things worse and everything I do now just doesn't seem to be helping. We've seen some improvement lately at the cost of other things but I'm constantly worried about him and if he'll ever get back to his old normal, or something approximating it. Maybe I'm just looking for words of comfort that he'll be okay or that at least we're doing something right for him.
Thank you all! I appreciate any input you all have. Hope you and your kitties are doing well.