PU Surgery Recovery and Unexpected Issues

leighthecat

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Hi all! This will be pretty super, extremely long as my boy Neko has a lot of ongoing issues leading up to our current predicament, so apologies in advance for the wall of text.

Neko turned 11 on April 30; he's a big (and unfortunately overweight) boy at about 19.5 pounds. He was diagnosed (via ultrasound) with IBD in April 2016. After a short-course of prednisolone and changing his food to Nature's Variety Limited Ingredient Rabbit Diet (dry kibble - he wouldn't eat wet food), things were fairly resolved. He had a flare-up early in 2018 because his big brother was experiencing his own health problems and I'd been switching foods and giving Neko treats that I shouldn't have, and he ended up with bloody diarrhea and increased vomiting. We changed his food to Royal Canin Ultamino (dry kibble) and he was on 5mg daily prednisolone for several months before being weaned off of it.

Neko unfortunately lost his brother in April 2020, and I brought him to the vet afterwards for a full check-up since he'd been vomiting more frequently, thinking maybe stress was causing an IBD flare-up. An ultrasound showed intestinal inflammation consistent with IBD, but also showed a significant amount of sand and debris that had accumulated in his bladder. He hadn't had any issues peeing that I'd noticed, and with his IBD reasonably well-controlled, we were reluctant to switch him to a urinary diet that would cause intestinal issues. The vomiting continued, so he's been on 5mg daily prednisolone since November 2020, with occasional decreases to 2.5mg daily when he felt up to it. In May 2021, he was in for his check-up and his vet felt bladder stones. Neko was scheduled for a cystotomy, which he had in July. It was a nightmare recovery as his bladder was full of tiny bits of debris and stones that all had to be scooped out. After about 6 weeks, he finally stopped peeing blood and was getting back to normal (happy to discuss his procedure with anyone interested, as it was not like most experiences I've read about online - he seems to have slower recovery times, poor boy). The stones/crystals were calcium oxalate, but we opted to keep him on his Ultamino and add in a potassium citrate/cranberry supplement and hope this was a one-off.

In April, Neko had a little bit of diarrhea, which is unusual for him. He then had intermittent soft stool and regular; he was about due for his annual check-up, and since the diarrhea wasn't chronic, I thought it could wait a bit. Then I went out of town for work for a few days, but when I got back, things seemed off with him (I'm sure most of you know what I mean - something that I couldn't really explain, just different). Then he went from licking his bowl clean and hounding me for food to not being so interested but still eating everything (I thought he was just off his routine since I'd been away), then he started eating about half of what he usually did over two days. He vomited a couple times, and one night it looked like his stool was very dark, and mushy. I brought him to the vet first thing the next morning; his blood tests were fine, fecal exam didn't show anything unusual, and x-rays showed a possible bladder stone and a moderately full bladder. The following day, he went for an ultrasound, which showed some intestinal thickening consistent with IBD (they didn't believe it looked indicative of cancer), but his bladder was again full of sludge and debris, and also large. He hadn't peed while he was at home overnight, and apparently he hadn't peed while he was staying at the vet either. He hadn't even tried to pee - he had ignored his litter box, although the night before he had been drinking a water somewhat aggressively. He'd been peeing up to that day, though. We immediately brought him over to his usual vet, who drained some urine from his bladder to send for testing. We discussed what to do and because of the recent cystotomy and the possibility of a blockage (he couldn't be expressed), we landed on the PU surgery as the best course for him, as the crystals/sludge were likely calcium oxalate (they did turn out to be) and wouldn't dissolve on their own and would cause further blockages without intervention.

I really thought I was prepared for every eventuality after his cystotomy. I checked with his vet and had things all ready for him on his return home: additional prednisolone for inflammation, marbofloxacin for UTIs (he had developed one immediately after his cystotomy and it was miserable, so we started him preemptively), gabapentin for pain, Cerenia for nausea and as a urinary anti-inflammatory, and subq fluids (50ml every other day to help hydrate and flush him out). We were also going to switch him to Hill's C/D, which I was nervous about as it's chicken-based and Royal Canin S/O Calm wet food which is fish-based; his IBD seems to be exacerbated by poultry and fish.

Things went really, really shockingly well the first several days (although he refused to use a litter box that had Yesterday's News or shredded paper in it - he would only go in his usual box that has Pretty Litter). However, he also started holding his urine (he'd go once, maybe twice a day, sometimes it'd be over 24 hours before he'd go). I was in constant contact with the vet and bringing him in often for check-ups on everything (they are a fantastic team), and everything always seemed to resolve although he had a little discomfort and was probably stressed (and I wasn't helping as I was and still am a giant puddle of anxiety). We started him on some prazosin after a few days, which made him pee after 20 minutes the first few times he took it....then he went right back to long instances of not going or even trying to go. His stool, meanwhile, had been a mix of diarrhea, soft stool, mud pies, and normal poo, but the day of his recheck of his sutures (just over two weeks out from surgery), he had diarrhea and vomited. We tried metronidazole for the diarrhea, but after a couple days he was still having diarrhea and vomited again so we put him back on just his Ultamino (and his potassium citrate/cranberry supplement), which stopped the vomiting, and he was acting a little more like himself but still quite subdued. He was on metronidazole for about a week, but the diarrhea didn't resolve. Then I added Fortiflora to his food, which he loves. We stopped the metronidazole and I was hoping that with the Fortiflora, his gut bacteria could restore itself and we'd be back to normal soon. That was about 10 days ago, and we're still having a mix of diarrhea, mud pies, mushy but formed stool, and one lovely instance of a normal solid stool last Tuesday. Now he's started on Tylosin (3x daily). We gave it to him twice yesterday (it's supposed to 1/16 of a teaspoon, but I think he had less because I just estimated and honestly could not eyeball 1/16), and I only gave it twice because I'm concerned his system is overloaded and wanted to start gradually. I have to give it in capsules because he won't eat it on his food and I'm not sure the capsule fits the whole 1/16 teaspoon (they're size 4, and I got a 1/16 measuring spoon to check). Anyway, Neko went about 31 hours without a #2 (when he had been going about 3 times daily), so we were really optimistic that things were firming up, and when he finally went there was a really nice solid piece....and then diarrhea. About 12 hours later, he had diarrhea again.

His personality, aside from before/after he has diarrhea when he gets uncomfortable, is reasonably normal (not quite 100% though) - when he's feeling good, he's chatty, super into eating, drinking out of his fountains, and laying around comfortably in the sun and on his blankets. He will pee once or twice per day, but sometimes needs encouragement to go to the litter box. He seems to have a strong stream when he does go, though, but today it was a little smaller than usual which naturally sends me into a panic (maybe he's slightly dehydrated from the diarrhea).

I am riddled with anxiety so maybe this is more of a vent session, but has anyone else experienced something like this, both the diarrhea issue and the urine holding? Is he just overloaded with antibiotics and between that and the diet change, his tummy is super unhappy? I thought about adding S. boulardii as another probiotic but he's got so much going on, I'm afraid of making things worse. Obviously we just started the Tylosin but I guess I'm looking for immediate gratification when it will likely be a lengthy process to get his system back on track. I'm happy for any/all advice and really I just appreciate you all listening (or reading)! Neko is a sweet boy and he's been through a lot this past year and I want so badly to see him healthy and happy and back to his usual self. Thanks all!
 

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Hi
I'm reading that tylosin is short term, and can cause diarrhea, but there seems to be conflicting info.

Anyway, fortiflora isn't a very good probiotic. If you decide to use one that's better, you need to use a prebiotic as well. There are brands that are both together.

Try to find a way to ease your own stress, exercise, meditation, whatever because he's a sponge for your emotions.

Can you find a wet food, even commercial raw for him?
 
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leighthecat

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Thank you for your response and your suggestions!

I saw that tylosin and metronidazole both can have diarrhea as a side effect, but I'm not sure what to do with that information besides try a little longer to see if there's an improvement (or if things get worse). I'll look for a better pre/probiotic for him in the meantime, though, maybe that can mitigate things!

I'd like to get him on a quality wet diet because I think it would help with a lot of problems. Right now though, I'm concerned about switching foods again since his tummy seems to be very unhappy, and it will be harder to tell if the diarrhea is a continuing issue from whatever is going on now or a reaction to a new food.

I will try better to manage my stress levels around Neko! The vet said the same thing. I tend to go to pieces whenever we experience a setback. At least he's gone longer between his #2s, and there was a solid bit earlier so hopefully that's some progress!
 

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His gut flora is most definitely out of whack with taking antibiotics, and now more antibiotics are in the mix. I second that a good pre/probiotic might help. S. Boulardi could help too. Not sure how long ago the PU surgery was, but the diarrhea may have been exaserbated by the surgery (with antibiotics) and follow-up antibiotics, etc., etc., etc.

Are you monitoring his PH levels to make sure no more of those crystals form. Even after P/U surgery than can form, so monitoring the PH levels is critical to my way of thinking.

Hydrate, hydrate, hydrate. And keep up with the potassium citrate.

I'm thinking the diarrhea should resolve after his gut flora has a chance to recuperate once all the meds have stopped (except the pred). Poor baby
:frown: You've both been through the wringer.
 
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leighthecat

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Thanks for your response! Neko's surgery was four weeks ago Wednesday. I think you're probably right about the antibiotics/new food/stress/surgery giving him diarrhea initially and then everything else making it worse, but the overprotective side of me is in panic mode about it all and wondering why things can't be normal for him already.

I've got a prebiotic/probiotic on the way that I should be able to give him tomorrow (it's Fera Prebiotic/Probiotic). I do have pH strips to test his urine but he's been so...not necessarily litter box averse, but a little reluctant with it, so I haven't wanted to get too much in his business. He uses Pretty Litter and it's been yellow every time (even pre-surgery), except for his first pee after his surgery when it was blue-green. So I think that can indicate normal pH, but also potentially acidic, which follows with the calcium oxalate crystals. I'll try to get the actual pH to check. How would I fix that, though? Is it a matter of hydration or is there a supplement beyond the potassium citrate that would help?

Neko is still getting fluids and we're continuing with that, especially given his diarrhea. He has two fountains and loves to drink out of syringes that we use for giving him water with his pills. Even so, with the dry food, I'm not sure that he hydrates himself the way he needs to be (without additional fluids).

Do you think I should talk to his vet about just taking him off the tylosin and give the real probiotics time to work instead?

Thanks again - you all have really made me feel less stressed and less alone in this. 🥰
 
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leighthecat

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Well, we ended up having a rough morning, unfortunately. Neko was ready for breakfast and I prepared it and gave it to him, then left him while I got his tylosin ready (I figured I'd give it until the vet says otherwise). When I came back, he'd had eaten some of his breakfast but stopped - unusual for him and a bit of a red flag. But, I pressed on and gave him the tylosin and then some water, after which he howled and then vomited (food and the pill). I don't think it was the tylosin even though it has a bad flavor, since he was a little off before he had that.

He drank a little water after that. Then he went to his litter box and had liquid diarrhea. And then, he vomited again (just water this time). So I've contacted his vet who hopefully will get back to me soon about next steps.

Neko's new pre/probiotic came in and about four hours after he last vomited, I gave him some lunch with about 1/4 scoop (per his weight class he should get a whole scoop but I'd rather start out slow, maybe with 1/2 scoop or less today). He was very eager to eat, at least. It's settled for about an hour so I might give him more soon.

It really feels like everything I'm doing/have done to try to keep him healthy and comfortable just makes him feel worse. I'm not planning on giving him the tylosin for the rest of the day, at least, and I'm also going to give him some additional fluids. Hopefully the probiotic helps some! I'll keep you posted on what the vet says. He's just never had really chronic diarrhea lasting this long and rarely vomited while on his prednisolone and regular food. I know his system is so out of whack...I'm just really ready for it to be back to normal (I know Neko is too).

Thanks for the support and caring!
 

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Hi. I am sorry for all you and your cat are going through.
What were the stones that were removed from his bladder? I thought you had mentioned calcium oxalate but then later said they weren't. Cats can still get blocked after a PU surgery.
Has a specialist done a full abdominal ultrasound to look at his kidneys and ureters as well as his bladder? What kind of stones did he have? Have they done a decal PCR? It is a test to the lab to see what is going on and guide antibiotics if needed.
Could he be painful? Is he on anything for pain? Is he on Prednisolone now? He won’t eat any canned? Check out the website cat info.org.
 
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leighthecat

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What were the stones that were removed from his bladder? I thought you had mentioned calcium oxalate but then later said they weren't. Cats can still get blocked after a PU surgery.
In July 2021, Neko had a lot of calcium oxalate debris and some stones (2, I think) removed during a cystotomy. But, his urinalysis from April 26 showed that he had a large bladder full of sludge/debris again, and that turned out to be calcium oxalate crystals. I don't believe there are stones (the ultrasound vet only said debris). I hope he's not blocked; I'm monitoring his urination carefully but he does sometimes need encouragement to go to the bathroom. When he was initially blocked (we are reasonably certain he was, at least), he wasn't showing typical signs of a blockage. He just didn't go to the litter box at all, was eating less, and had a couple vomiting episodes. He wasn't straining, or in and out of the litter box, or licking excessively, or going/trying to go somewhere other than his box. And that makes me worry that I won't recognize a potential blockage for what it is.

Has a specialist done a full abdominal ultrasound to look at his kidneys and ureters as well as his bladder? What kind of stones did he have? Have they done a decal PCR?
Neko had a full abdominal ultrasound on April 26 - the vet said everything looked great (liver, kidneys, pancreas, etc.) except for his intestines, which had mild inflammation consistent with IDB (she didn't suspect lymphoma at this time) and his bladder, which was large and full of debris again. He also had a chest x-ray (I had a panicked night about his breathing and requested it) but his lungs and heart looked good as well. His blood test was normal. I don't think that a PCR was done, just a regular urinalysis. I'll ask the vet about it, though, and see if they can do that to get more information.

I brought him to the vet several times in the two week post-surgery, and they ran the ultrasound wand over him and did x-rays; it didn't look like anything had been causing a blockage, but there is still debris in his bladder that they are hoping enough fluids will flush out. It wasn't the full ultrasound like he had at the end of April, but still something.

Could he be painful? Is he on anything for pain? Is he on Prednisolone now? He won’t eat any canned?
Neko is on 5mg prednisolone daily - that hasn't changed except for an increased dosage to help with inflammation right after surgery (then it was 5mg 2x day). He doesn't seem to be in pain or uncomfortable except for immediately prior to/after the diarrhea (and the vomiting this morning). I have gabapentin left over from his surgery so I can try that later if needed.

When we tried the Royal Canin S/O canned diet, he would eat it sometimes. Once he ate nearly an entire can, but more often it would just be a couple bites here and there or he'd be uninterested entirely. It's also fish-based, and that makes his IBD flare, I think, so we took him off of it. I would like to transition him to an appropriate wet diet but his poor tummy is so upset right now I'm afraid of making things worse (not that what I've been doing seems super helpful to him to be honest). We have a bag of Royal Canin Hydrolyzed Protein/Urinary diet to try as well in case canned doesn't work out, since that might gentler for his IBD.

Neko's eaten a bit today (almost half of his daily allotment) and is resting in the sun, so that's a bit of an improvement. We'll give him fluid soon so he won't get dehydrated.

Thank you for your response. Please let me know if there's something else you think I need to address with his vet or more questions I should be asking. I thought I was really well-prepared for everything but I've felt so overwhelmed the past few weeks. I've been fortunate that Neko has been really good at the vet, and they've always worked with me to get him seen as soon as possible.
 

silent meowlook

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I would think that if this isn’t resolved quickly, it’s time for him to see a board certified internal medicine specialist veterinarian. Calcium oxalate crystals are not seen in cats that often. I have to wonder what is going on that they rare reoccurring.
you give him bottled water, not tap, right?
 
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leighthecat

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Yes, Neko's only gotten bottled water over the past year (actually a bit longer, now). We have hard water and I thought that might have been the issue, though he had filtered tap water prior and our other cat never had any bladder issues. The Ultamino supposedly helps stop crystal formation, but he's been eating that since 2018 and still developed problems (but he was asymptomatic and we only knew when he had an abdominal ultrasound to check on his IBD). He is overweight, has developed arthritis in his elbows (it became pronounced after his cystotomy), and isn't particularly active, so I'm not sure if that's a maybe easy-to-fix reason why we're seeing these issues. Still, I was shocked and so was our vet when the crystals returned in force within a year.

There is an internist in the area; I had brought him there in 2018 for his IBD. It's a 30-minute drive and he gets so stressed out he's visibly shaking and panting. Then his glucose level is slightly high, so they would want to do a re-test in two weeks and the same issues would arise, and rinse-repeat. I'm sure it's worth re-visiting, though, to get him back on track and resolve his crystals (and the diarrhea if it persists).

Thank you!
 

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As far as how to treat if his ph gets out of whack, I would l discuss that with the Vet also. With those particular crystals, it's kind of an unknown. I know the potassium citrate is supposed to help keep the ph in balance, so it's possible that might need to be increased, depending on how much you are giving him. Or possibly a lower calcium food might be needed. But I did read too that overweight cats are more prone to these than average weight cats. Do you free feed him? Have you tried to get him to lose weight? I know now is not the time to do that, but have you tried in the past? Once things get squared away it might be a good idea to try by limiting his calories and trying to get him to exercise more. We can help you with that when you are ready.

Normally with IBD we really stress non dry food, but with his history of this particular crystals, I'm really at a loss of what to recommend. BUT, I'm thinking since the food isn't keeping them away, if you could switch him over to wet, it probably would be best, and this diarrhea and vomiting could absolutely be a result of the IBD (along with lack of good gut flora). I mean, that's how IBD reacts when it's not "happy". The pred should be helping though. Is he also on Vit B? since the current food isn't really helping, perhaps you could try ANY wet food to see if there are some out there that he likes? Of course, discuss this with your Vet because I suppose there is a slight chance that the food has helped and it could have been worse.

Keep us posted on how he's doing. Hope the Fera helps. I've used it before for my guys. Starting slow is good. Sometimes they reject it if you give a full dose in the beginning.
 
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leighthecat

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But I did read too that overweight cats are more prone to these than average weight cats. Do you free feed him? Have you tried to get him to lose weight? I know now is not the time to do that, but have you tried in the past?
We have been trying for the past year to get Neko to lose weight, with some success. When he went to the vet in May 2021, he was 21.8 pounds, and I'd been feeding him 3/4-1 cup of the Royal Canin Ultamino (no treats or other food due to the IBD). We started feeding him 1/2 cup of the Ultamino last May, and he's currently down to 19.4 pounds. That's only 167.5 calories per day, so I'm reluctant to go lower on that - maybe that's the wrong way of thinking, though. He doesn't have any thyroid issues that would stall his weight loss, and like I said, he's not very active. Unfortunately, when his brother passed, he lost his favorite toy. We try to engage him and we have an astounding variety of toys (wand toys, kickers, activity mats, balls, catnip toys, laser pointers, etc.) but even toys that he used to love chasing around (like ponytail holders) don't interest him anymore. He likes to lay on his perch in the sun and catch toys you throw to him, or chew on his catnip toys. I was hoping that once he recovered from the surgery (and obviously my timeline of that is all messed up) that we'd be able to address his arthritis to get him moving more, which would help his weight, which would in turn help with his urinary health.

Neko isn't currently taking Vitamin B, as he hasn't shown a deficiency with it on his bloodwork. I'll ask the vet about that when I talk to him as well, though. I wonder if temporarily increasing his pred dosage would help with inflammation as well right now.

He always did well on his Ultamino, so I was hoping changing back to it after the Hill's C/D (and we weren't even able to fully transition him over a couple weeks) would help with the tummy issues. The only thing stopping me from trying a new wet food right now (and I don't think the Ultamino or Hydrolyzed Protein diets come in wet form - I'll check with the vet) is that I'm really afraid to inflame everything even more since he's pretty sensitive to a lot of foods. I did order a food intolerance test that maybe will help - I'm hoping it can at least guide me to the best options for his future food.

I really appreciate everyone's help, support, and suggestions! It's been really tough over the past several weeks and such a setback after last year and I've been honestly having some trouble holding it together when it comes to him. I worry about him all the time (as we all worry about our babies when they're not feeling well).
 

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maybe that's the wrong way of thinking, though
Not necessarily, the only right way for a cat to lose weight is slowly.

What if you put his food in places that he has to walk, or even jump a little bit, to? Up steps, if your house has them?

Maybe eventually you can get him outside :)
 

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Hi. I’m doing talk to text so hopefully this makes sense. I’m driving home from work right now.

So, the problem with the dry food is the carbohydrates. That’s usually what is making a cat fat is the carbohydrates in the dry food. Some cats tolerate these carbohydrates better than others but many cats do not tolerate them well and become obese. Cats are strict meat eaters they are not meant to have carbohydrates. Every dry food is high in carbohydrates. It’s not just the lack of moisture that is the problem with the dry food it is these carbohydrates. The food can say It is green free but that really doesn’t matter because when they take out the greens they’re putting in potatoes and other high carbohydrate foods and that’s what cats don’t process well. They do make the hydrogenized protein diet in a canned version. It looks like Play-Doh and is not very appealing to cats. My personal cat who has IBD and intestinal lymphoma. She eats the Royal Canaan venison diet canned. It’s not cheap. But she does eat it and she does well on it. If you were to switch them over and get them to eat a canned food you would not have to worry about limiting any amount of food because he would just naturally lose weight because he was no longer getting the carbohydrates.

With an overweight or obese cat, they must eat. You cannot have them go on a hunger strike or even skip a meal. They are a great risk for developing hepatic lipidosis if they do. That is a life-threatening disease that is mostly seen in overweight cats that stop eating. Or have their calories drastically reduced. It can be seen in normal weight and then counts as well but the most common presentation is an obese cat stopped eating. So regardless he hast to eat. If he absolutely refuses to eat canned food then there are things you can try to do to get him to eat. The website I listed above Cat info.org has a lot of good ideas on how to get a dry food cat to eat wet food. That site is written by a doctor Lisa Pearson. As for him reacting to a new food, he’s already vomiting right? If he’s already vomiting and having diarrhea I don’t see where it makes a difference. I forget if you said if you’ve tried a novel proteins source with him I think you had mentioned venison but I don’t remember now. I certainly wouldn’t increase the Pred right now if it was me but for sure ask your vet. The pride is also not helping with him to lose weight but if you don’t have a choice you don’t have

For the vitamin B, that is a very good idea. Low levels of vitamin B 12 or Kabbalah mean would not show up in routine bloodwork. You would have to have had them send out a special test to a special lab check and cobalamin levels. My cat like I said has IBD and intestinal and Phoma and I give her injections of vitamin B 12 in her fluids. I do like once a week I know some cats that are on once a month it all depends. I never did the testing on my cat first because I wanted to start in right away with the injections. Vitamin B 12 is something the cat will get rid of if they get too much up it’s a water soluble vitamins so you don’t have to worry about an excess level in it in the cat.

Anyway just some thoughts. I hope he’s doing better. Oh and as for the trip to the specialist being stressful for him, ask your veterinarian for a prescription of gabapentin that you can give him the night before a visit and two hours before travel. It really works well to make unhappy kids happy cats. I think he may have mentioned that you had some already. Gabapentin was originally a human epilepsy drug called Neurontin and they found it to have good effects for neuropathic pain. It doesn’t do a whole lot for other kinds of pain but it does for some reason make an unhappy cat happy. Of course you have to use it in large enough doses. There’s also trazodone which if the gabapentin isn’t enough sometimes veterinarians will add that as well of course you would have to check with your vet on all of this. But he should never be stressed to the point of panting. That’s not good for him it’s not good for anybody. What is it we always say you don’t want the diagnostics to kill the cat. So I would Ask for gabapentin if you don’t already have it.
 
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leighthecat

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Thank you so much for the information! I absolutely understand the concerns with Neko's food - once his tummy is feeling better, I'm going to work on switching him over to a wet or at least a hybrid diet.

In good news, I talked to the vet and we increased Neko's prednisolone dosage, and between that and the probiotic, we finally got some solid #2s starting on Friday and the nausea seems to have gone away (and I really hope I'm not jinxing myself). We're going to stay this course until he's stable for a while, then taper down the pred and work on the diet changes (for both weight loss and bladder health). I've also ordered B-12 and I'm still waiting for it to be approved - I was planning to give him the injections myself instead of stressing him out with vet visits.

Regarding exercise, I do want to try to walk him outside, so I'll talk to the vet about what's needed for him to do that; my main concern is that we have a lot of wildlife in our area and I don't want him exposed to any diseases they may carry (the raccoons just love to do their business in our yard). Neko's never been much of a jumper beyond small ones (e.g. to a windowsill or the bed) and we don't have stairs at our house; he used to like to chase ponytail holders when we slid them across the floor but he's not into that anymore. I'll figure out something for him; we have an absurd number of toys so hopefully as he loses weight he'll feel like being more active and interacting with some of them.

Thank you all for your help - I was really anxious last week and all your advice really made me feel so much calmer and like I had options. If/when something new pops up, I'll be sure to post again. Hope everyone and all your babies are doing fantastically! 😻
 

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I'm so glad he's doing better with the increased Pred.

As far as exercise goes, have you ever tried a D'Bird? My guys go crazy for it. My only issue is I don't really have much room to use it, but if you have any space at all, it's a great interactive "toy". I'm sure you find all kinds of videos on Youtube of cats playing with it.

The only issue I can see with trying to incorporate outdoor walks is that if he's never been outside it might cause a lot of stress on him and stress is not good for uriniary issues. But even if you don't have stairs, you might be able to get him to follow you all around your house be carrying his food dish around before you feed him. Some people have good luck with that. My cats also love to run for their treats. I toss them down the hallway and they run and even jump for them. I've got a great outfielder in one of my cats :lol:. Just don't use too many treats or make sure they are small since they can be caloric.
 
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leighthecat

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Hi everyone,

I know it's been a while but I wanted to give an update on Neko and get everyone's opinions on what's going on. Frankly, I'm a mess (more so than usual). So, the diarrhea never really resolved - it would always be intermittent; sometimes we'd get lucky and have a nice poo, but it was too frequently still very squishy or mud pie consistency.

Last Monday (June 27) I felt like something was off again, primarily in his enthusiasm with his food. his appetite had been voracious and then it was kind of lackluster but he was still eating. On Wednesday, he threw up over night (2:30am) - a lot of water/liquid. In the morning, he didn't want any food, and eventually around 9:30am I gave him some Cerenia to calm his tummy, which he promptly threw up with the three pieces of food he managed to keep down. He went to the vet and they gave him a Cerenia injection, and the whole day he was so lethargic and listless - but he did end up eating. On Friday, he still seemed nauseated and when I weighed him at home, he was 19.0 pounds, which scared me - it was .3 pound difference from when he'd been there last (although the last time I'd weighed him at home he 19.3 pounds on June 15). We went in to the vet again, they weighed him at 19.3 pounds and things seemed all right with him, and we didn't change anything.

Then Neko started having diarrhea again on the 2nd. He was still eating, but not as well as he had been. And on the 4th, he threw up a lot of smelly bile at 11:15am and had diarrhea about 7 times that day. He was miserable and only ate about a tablespoon of food. So, back to the vet on the 5th. Since he'd been involuntarily fasting, we got the Texas A&M GI panel done, as well as a regular blood test, urinalysis, a PCR fecal sample (although it was from just prior to midnight and I let it sit in his litter until about 6:45am), and x-rays. We were also referred to an internist, who, by some miracle, we were able to see yesterday (there was a cancellation). I've attached the results of that visit here (I'd also like to say that our regular vet, Dr. Troia at New Hope Animal Hospital has been amazing through everything we've dealt with for Neko, and Dr. Thiesen at Central Texas was amazing, knowledgeable, and really listened to everything we had to say). Some of the history details are slightly off but not so much as to be impactful on anything.

To make a long story longer, it's very possibly small-cell lymphoma, but could still be IBD, which I am of course hoping for. We're treating it right now as a bacterial imbalance so hopefully we can see results soon. The vet didn't seem overly concerned about the heart murmur, which is a new thing - it wasn't noted on the x-ray he had on May 11 but the radiologist looking at the x-ray this time said the heart was slightly enlarged. To add to all that, Neko hadn't peed since 1:55am on July 4. I was chalking it up to dehydration due to the diarrhea, and then panicking about it, and at his regular vet they were able to express him to get urine out for his sample; the internist yesterday was able to express him fully as well and thinks he just has a mental block about peeing (hence the anti-depressant). The regular blood test came back unremarkable, and the urinalysis show crystals still prevalent in his urine but no infection. There are no stones in his bladder. We haven't gotten back the GI panel or fecal PCR yet.

I'm not sure how his current ultrasound compares to what we had in April - I've asked our regular vet so maybe he can let me know.

I've ordered the probiotic Dr. Theisen suggested, which is on its way, and we've started the fecal transplant pills as of yesterday. I understand we're super early in the process - but, guys - I am freaking out. Neko is my world and I hate him seeing him so tired and listless and not interested in eating. He doesn't wake me up for breakfast, he barely talks anymore, and he hasn't been my little shadow for a week now. I'm so scared for him and I'm second guessing myself about whether we should have started the chlorambucil or not. I'm not sold on the biopsy since he's on the prednisolone right now, plus he's been through two major surgeries the past year, and with the heart murmur...I'm just not comfortable. To add to things: my husband and I have a trip coming up next week that we planned in January for our 10th anniversary (our first vacation together since 2014). I am TERRIFIED to leave Neko, even though my mom will be watching him (staying with him, actually) and it's only for about 4.5 days. I'm afraid he'll stress out, or won't get his meds, and I am all for cutting our losses and not going anywhere, which my husband is pretty set against (he lost his father late last year, who said he regretted not doing more while he was still able to - a driving factor in the need to go somewhere and do something other than cat-caretaking, which I absolutely understand, although I think at this point much of my identity just centers on Neko). And if we stay and things are fine, then I'll feel bad about denying us an opportunity.

I honestly appreciate you all just listening - I don't have a lot of people to talk to who really understand how much our kitties mean to us and how awful and traumatic it is when they're unwell. If anyone has any advice on what I should do or can offer any interpretations based on his appointment, I'm happy to hear it. Thank you all again!
 

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