Persistent blood in stool, clinically healthy cat

gabicards

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Hi all,

I adopted a lovely kitten 2 months ago, and about 2 weeks after his arrival he started having soft stool with some blood, and he also had a lot of gas. We tested him for parasites and it came back positive for coronavirus. We changed his food twice before settling on a Hydrolysed kibble by Purina Pro Plan. He's been eating nothing but this kibble for 20 days now (no additional probiotics, no medication), his stool has regained form and he only goes once a day (rarely twice), he's not passing gas at all anymore (that we see!), but there's often a little blood still.

We had an ultrasound done that shows inflammation:
Some segments of the jejunum are visible with a slight increase in thickness, the ileum and cecum with a moderate increase in parietal thickness. Images may be related to an inflammatory process – enteritis associated with typhlitis.

Sonographic images visualized in colon segments suggest reactive lymphoid follicles, images may be related to inflammatory injuries. Descending colon with mild to moderate increase in parietal thickness – colitis. (Translated from Portuguese)


His original vet, who's more of a generalist (and whom I really like) thinks it's highly unlikely this has anything to do with FIP, and is leaning towards a food allergy (which is why he's on hydrolized kibble now). The gastro specialist is concerned - although she did say she doesn't think it's FIP, she's afraid of giving him medication because anything for the inflammation would be immunosuppressant, which could trigger FIP. She recommends doing an endoscopy. She told me about a case she had in which the treatment for IBD ended up "triggering" FIP (this isn't the wording she used, of course).

I was initially convinced of doing the endoscopy, but now I'm under the impression it wouldn't give us a FIP diagnosis anyway, and it would certainly stress him. My mom is driving me insane saying we should try a different food, again (novel protein this time), but I'm afraid of switching and irritating his intestines more. If I keep him on the Hydrolized kibble, and if it's indeed a food allergy, how long should I expect this persistent blood to stop appearing? Is it risky not to do the endoscopy?

Some more context: he's a purebred Maine Coon and the runt of the litter. Resisted kibble longer than his siblings did, wanted to stay on mom's milk for a couple weeks more (I think, based on what the breeder told me), and that's around the time his growing slowed. She did blood tests on him, a heart echography, something on the liver, and everything came back normal. He was 1kg by the time his biggest brother was 2kg. I adopted him at 5 months old and he was 2,7kg, he's now 7,5 months old and 4,7kg. His breeder told me he barely ate kibble, he was more dependant on wet food, which was Royal Canin Kitten. I gave him N&D Kitten (with grains) when he arrived, he ate it, and a couple of weeks later the symptoms started. He didn't have diarrhea at all in the beginning (I thought moving to a different home would cause it, but it only started weeks after). We then switched his food to Royal Canin Gastrointestinal, which didn't help, then Pro Plan Gastrointestinal and finally the Hydrolized one. He's never had anything else - nothing on his skin, no vomiting, normal behavior (playful, sleepy, cuddly, with occasional zoomies).
 
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FeebysOwner

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Hi. I don't know how much of anything I can offer, but did the vet actually say they wanted to look for FIP via an endoscopy? Some vets will do a fine needle aspiration on 'suspect' tissue when an ultrasound is being done, but that doesn't sound like that happened. So, perhaps the vets near you perform an endoscopy in order to obtain tissue samples instead of via ultrasound? Or the endoscopy might have been suggested to look more thoroughly at his stomach tissue?

As Furballsmom Furballsmom suggested above, has anyone discussed putting your kitten back on the RC food he was on when you got him - before he started having any issues?
 
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gabicards

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Hi Furballsmom Furballsmom and FeebysOwner FeebysOwner !

The initial kibble was a bit complicated. So, the breeder told me she had been feeding him N&D Kitten, this version. I took the reference to the pet store and bought what I thought was the same, but it turned out to be slightly different - it had grains. The version he ate after arriving at my house was this one instead. Once we realized the mistake, we started to transition him out of it and back into the grainless version, as the vet said they are similar enough that it shouldn't cause any issues. The soft stool started happening soon after, and the blood with it.

We've never discussed putting him back on it. Ever since then, the theory has been that some type of food intolerance is at play, so we eventually switched to hydrolized kibble.

"So, perhaps the vets near you perform an endoscopy in order to obtain tissue samples instead of via ultrasound?" yes, the endoscopy is in order to get a biopsy of his intestines. What's unclear to me is why she wants a biopsy... she isn't keen on medicating him with something that could impact his immune system because we know he has coronavirus. So I don't understand how an endoscopy would make that better?

Some googling (this) is making me think the vet is actually trying to identify whether he has IBD or a lymphoma, which makes more sense than throwing the possibility of FIP around (and I suppose would justify the biopsy?), but that's not what I'm actually hearing, which is confusing.
 

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If this were me, (realizing it's not :) ) I'm with your mom's perspective, but only up to a point. I would put him back on the RC wet kitten food.

Point being, get him off of kibble, since the breeder mentioned he didn't really like it compared to wet food anyway.
 
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gabicards

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If this were me, (realizing it's not :) ) I would try him on the RC wet kitten food.

Point being, get him off of kibble, since the breeder mentioned he didn't really like it compared to wet food anyway.
I'm eager to change the food too - but I'm told change should only happen after 3 months on the hydrolized kibble, because even with a slow introduction to other food it can irritate (more) his intestines. :(
 

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You're pretty much caught between a rock and a hard spot, if you decide to follow the vet's directions.
 
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gabicards

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I think you're right. I'm inclined to believe this intestinal irritation might be the cause of his slower growth in comparison to his brothers. but I'm scared of poking about and end up making whatever issue exists worse for him.

One of the most confusing things to me is I can't tell if the food is helping, because one vet is optimistic, while the other seems anxious. One tells me I need to give it time, and the symptoms should resolve in up to 3 months, while the other told me today symptoms should have all but resolved within the first week. There's a huge difference between the two, and my brain is turning to mush.
 

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So, he has not been back on the original wet food which was RC Kitten? What made you second guess the food you transitioned him to after the breeder had fed him N&D? Was he starting to show issues then? And, how long had the breeder fed him the N&D after moving him from the RC kitten? I am just wondering, as also just suggested by Furballsmom Furballsmom , that he may just have an issue with something in most any dry food. And, if the breeder hadn't fed him N&D for very long, the problems still could be tied back to that - and, dry food in total.

As far as the endoscopy, I am not clear myself on what analysis is done on tissue to confirm IBD, so that aspect would need to be investigated more. Although it is not impossible, he is awfully young for lymphoma - but, IBD can be caused by an intolerance to foods. Get rid of the intolerance, you could get rid of the IBD, albeit slowly without additional aides like steroids.

The thing is either with IBD or lymphoma, cats are generally placed on steroids (and chemo for cancer), so yes, I see your point in that the vet is so worried about suppressing his immune system enough to provoke coronavirus mutation to FIP, what will she want to do if it turns out to be either?? Also, ask her if he were to respond quickly to a steroid, and then it is removed, what are the odds of that compromising his immune system?

I am not encouraging you to ignore the fear of FIP, but you do realize that most cats contract coronavirus young in life and a very small percentage ever have it mutate? Ask the vet about testing to decipher between the two versions of coronavirus, one which doesn't seem to mutate to FIP. I tried to find one of the articles I had previously read, but so far, I have not found it. I also don't recall how reliable the testing is.

The 3-month trial on a new food is to ensure it has enough time to 'take effect'. How long now has he been on it, and has there been any improvement at all? I'd still ask the vet about going back to the RC Kitten which he was eating with no issues, especially if he wasn't on the N&D for very long before you got him - it and the kibbles you have given him could all be causing the same issue, for whatever reason.
 
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Furballsmom

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There's a huge difference between the two, and my brain is turning to mush.
Hang in there with this, ask your Mom to be patient with it all, and keep your fingers crossed that the three months goes by really fast and that his stool clears up if this is the route you decide to take.

But my bottom line is the same as FeebysOwner FeebysOwner :)
 
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gabicards

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So, he has not been back on the original wet food which was RC Kitten? What made you second guess the food you transitioned him to after the breeder had fed him N&D? Was he starting to show issues then? And, how long had the breeder fed him the N&D after moving him from the RC kitten? I am just wondering, as also just suggested by Furballsmom Furballsmom , that he may just have an issue with something in most any dry food. And, if the breeder hadn't fed him N&D for very long, the problems still could be tied back to that - and, dry food in total.

As far as the endoscopy, I am not clear myself on what analysis is done on tissue to confirm IBD, so that aspect would need to be investigated more. Although it is not impossible, he is awfully young for lymphoma - but, IBD can be caused by an intolerance to foods. Get rid of the intolerance, you could get rid of the IBD, albeit slowly without additional aides like steroids.

The thing is either with IBD or lymphoma, cats are generally placed on steroids (and chemo for cancer), so yes, I see your point in that the vet is so worried about suppressing his immune system enough to provoke coronavirus mutation to FIP, what will she want to do if it turns out to be either?? Also, ask her if he were to respond quickly to a steroid, and then it is removed, what are the odds of that compromising his immune system?

I am not encouraging you to ignore the fear of FIP, but you do realize that most cats contract coronavirus young in life and a very small percentage ever have it mutate? Ask the vet about testing to decipher between the two versions of coronavirus, one which doesn't seem to mutate to FIP. I tried to find one of the articles I had previously read, but so far, I have not found it. I also don't recall how reliable the testing is.

The 3-month trial on a new food is to ensure it has enough time to 'take effect'. How long now has he been on it, and has there been any improvement at all? I'd still ask the vet about going back to the RC Kitten which he was eating with no issues, especially if he wasn't on the N&D for very long before you got him - it and the kibbles you have given him could all be causing the same issue, for whatever reason.
He hasn't been back on RC kitten, no. He started showing symptoms on N&D (with grains), and the symptoms stayed after he was fully transitioned back into the N&D (without grains) for a couple of weeks, so that's when we switched to Gastrointestinal. I don't know exactly how long he was on N&D, but it can't have been more than two months and it apparently wasn't much of it, either, since she says she fed him 3 sachets of wet food a day because he wasn't keen on dry.

Yeah I know. Both vets recognize this too, which is why one of them is telling me not to worry, while the other is concerned. The older vet told me he has enteric coronavirus, but I don't know what in the exam shows that. I've assumed it's the location, since it was found in a stool sample. She told me it's very very very hard for that one to mutate, but don't take my word for it... I've gotten so much information lately, about my own health as well as my cat's, that I'm sure I'm making a mess of it all.

He's been on the hydrolized kibble for 20 days, and we do think there has been an improvement - all of the symptoms have pretty much disappeared, with the exception of the blood. He used to be quite flatulent, but we haven't noticed that at all since we changed his food, he was pooping multiple times a day (at his worst, he did it 7 times and it was almost liquid!), and now he only goes once or twice, and it's pretty regulated in that he mostly goes in the mornings, after breakfast. His stool has shape now - not too dry and not too soft, and barely has any smell. But every once in a while - I want to say every 3 or 4 times he goes, there's a little soft stool with some blood that comes out at the end. I've also noticed he has some itching under his head, on his neck. He's always scratched it a bit, it's always somewhere around his head, but he's never hurt his own skin (there are no marks anywhere). I've heard this could be due to a food allergy, but I don't know. I would not have been concerned about that behavior at all if someone we know hadn't pointed that out.

Should I wait the 3 months, for peace of mind, and then go straight to wet food for the next trial? Or would that be enough time to make the matters worse? I had understood that hydrolized kibble should, in the very least, stabilize him if it's some kind of food intolerance. It certainly hasn't made any symptoms worse.
 

FeebysOwner

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I guess if it were me, I would wait, especially since you say there has been improvement. If he prefers wet food, have you tried testing a dish of the kibble with water added to see if he would like it that way? Not going to change the outcome as to whether or not some of these foods are the problem, just to see if he would enjoy his food more that way.

I am still not sure that dry kibble - regardless of the brand isn't somehow behind this, given that you are now saying the N&D was the lesser amount of his diet compared to the RC Kitten food. So, more and more of the N&D, and less and less of the RC Kitten food, over time could still be the culprit.

The thing I am not sure about is whether or not he is having blood in his stools when they are more solid and you just can't tell it as easily. Keep an eye on that aspect too.

Since he is doing pretty well otherwise, you have some breathing room in terms of 'testing' food options. Keep at it, and please keep us posted!
 
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gabicards

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I guess if it were me, I would wait, especially since you say there has been improvement. If he prefers wet food, have you tried testing a dish of the kibble with water added to see if he would like it that way? Not going to change the outcome as to whether or not some of these foods are the problem, just to see if he would enjoy his food more that way.

I am still not sure that dry kibble - regardless of the brand isn't somehow behind this, given that you are now saying the N&D was the lesser amount of his diet compared to the RC Kitten food. So, more and more of the N&D, and less and less of the RC Kitten food, over time could still be the culprit.

The thing I am not sure about is whether or not he is having blood in his stools when they are more solid and you just can't tell it as easily. Keep an eye on that aspect too.

Since he is doing pretty well otherwise, you have some breathing room in terms of 'testing' food options. Keep at it, and please keep us posted!
Thanks for your reply! Yeah, I've wondered about the blood too - I was asked about it by the vet, whether the blood was mixed with the stool. I said it always came out at the end and it was bright red, which I suppose is an indication of where it's coming from... when the stool is more solid, it's still the same color - it isn't very dark. My understanding, from the vet, was that the blood in the stool would make it darker. I wonder if I misunderstood? I wouldn't know how else to look for it, to be honest.

I'll definitely keep hanging out here and trying to get informed. This has made me pretty anxious... my parents are confused because they think he's perfectly healthy and has already gotten better, but the blood is a huge source of concern to me.
 

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I'll definitely keep hanging out here and trying to get informed.
I'm glad :)
blood in the stool would make it darker.
Speaking of the color, as I understand it blood in his stool would make the stool appear very nearly black. Since it's bright red and doesn't appear until the end, it makes me wonder if he has a tear in his colon or rectum or something like that, similar to how with a human, bright red blood on the stool can be indicative of a hemorrhoid.
 
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