Repeating Rectal Prolapse

[Jabzilla]

Thanks Fionasmom! Cosmos deserves the best and I'm trying to do all that I can for him. <3 So is his food circus not unheard of? I've told vets about it before and they didn't have any answers. None of my other or previous cats would engage in such behavior either. I didn't know cats would sometimes want a certain ritual involved with their meals. I've heard of playing with your cats before feeding them, which I've tried. Cosmos ignores the attempt and just sits at the fridge. He doesn't always do the circus either, thankfully. I was looking at diy cat puzzles yesterday and am wondering if something like that would satisfy his desire for a game with food. Maybe putting his meat chunks into short jars so he has to figure out how to get it? Or maybe doing that with one piece and then having the rest on his plate, since when he does the circus, once he starts to eat he continues until his food is gone. Rofl, I guess that doesn't really get him to stop doing it entirely though and just shifts the game into a different form.

 

[fionasmom]

To me, the food circus sounds like something that makes sense to him or that he just enjoys as a game. If there were any indication that the ritual is tied into a lack of appetite, like following a pet around the house begging them to eat, then I would be worried but it seems like it is a game to him. Maybe he would go for the jars with pieces of food as it sounds like he enjoys whatever this is to him.

Every morning when I get the food for the three outdoor ferals, Rikki jumps on the counter (allowed in my house) and immediately starts to eat out of the can. If I offer him the same food from the same can on a plate, he jumps down and runs away. Go figure.

 

[gizzieblue]

That's fantastic news! Food circus sounds like fun! I has a cat that was not drinking water from any cat bowls or water fountain - and I was very worried. When he was a baby, he fell in the toilet - I taught he was playing water mill! And than I caught him drinking from from a tall skinny glass: he would dip his paw and lick his nails! He would drink from the faucet too! The glass placed on his food mat would remain untouched. So I had to have a glass w/water for Tzuchi on the counter!

My Bunny had her quirks as well :-) And you know the saying: dogs have owners, cats have slaves! Mango's got so many now, he's so plump [ it's normal for him, in winter he's puffy, in the summer he is just skin and bones - despite the juicy rats and being fed a full meal ].

If he is not licking his chest / excessively cleaning his face after eating, I don't think there's something to be worried about, If he does this, eats from a spoon rather than a bowl and might have a raspy meow, that yes. IMs, vets - they discounted this, even now for Meow. For Thor, my husband realized what was what going on.
But should have happen while on pred for sure as well.

Why was he on gabapentin? Really glad that he's doing better and getting his personality back! Oh, on a side: i found new dope for cats, maybe you guys now: Silver Vine for cats [ got it from amazon ]. Better than catnip [ or valerian ], Miau somehow smelled it and tried to rip the amazon box!

And again: ecid, and in my unprofessional opinion, you, know best.

 

[Jabzilla]

Our cats most certainly do have staff, lmao! I'm glad and relived to hear that there are other cats who have their own odd rituals and behaviors! I know I tend to be hypervigilant and always want to make sure something isn't a problem. I've started offering both of my cats treats in various sizes of toilet paper rolls for mental enrichment. It hasn't stopped Cosmos's meal time circus, but he seems to enjoy trying to figure out how to get his treats.

As for the Gabapentin, Cosmos had been taking that from the start of the prolapsing for pain. For the first couple of months, he would desperately try to groom his bottom when the prolapse happened and was clearly in pain/uncomfortable. I was very wary of taking him off of it, out of fear that the Gabapentin was what was enabling the prolapses to resolve on their own. I am quite pleased that he has reached the point where the prolapses still resolve on their own regardless of whether or not he's had the Gabapentin. I suspect he's been at that point for a while, since there had been multiple instances over the past few months of him pooping during a gap in the Gabapentin's coverage window and his prolapses still resolved without issue.

As for silvervine, neither of my cats seem to be affected by it. I got a silvervine stick with feathers at eat end. Cosmos will lick the feathers and bit the stick a few times, but that's it. Rocket ignores it entirely. Both of them will happily eat and roll around in dry catnip though. Cosmos will eat fresh catnip leaves too, but Rocket turns her nose up at them.

 

[fionasmom]

That is very good news that the gabapentin was able to be reduced or eliminated and Cosmos still felt fine!

 

[Jabzilla]

I have a cautiously optimistic update. I haven’t seen a prolapse on Cosmos since December 12th. Since then, he’s been happily zooming out of the litter box and I try to catch a glimpse as he goes by. He does a lap around my bedroom and when he comes back out there’s no sign of a prolapse. The whole thing has been consistently happening within 40-47 seconds (the timer starts as soon as his feet exit the litter box). I will continue watching though, as I want weeks worth of unseen prolapses before daring to say it may have stopped.

 

[fionasmom]

the timer starts as soon as his feet exit the litter box

I hope that this is concluding for both of you and that you can celebrate a lovely holiday season together! You could not possibly have done more for Cosmos.

 

[mrsgreenjeens]

I hope that this is concluding for both of you and that you can celebrate a lovely holiday season together! You could not possibly have done more for Cosmos.

 

[Jabzilla]

Thank you guys! <3 I got a good view of his bottom when he pooped this afternoon, and saw that the prolapsing is still happening. It's just resolving very quickly, which is still good.

 

[Jabzilla]

Welp, Cosmos has an appointment at the vet tomorrow afternoon. After three weeks of an ever increasing circus, he has now flatly refused to eat his before bed food. I figured maybe he's tired and wants something else. I gave him some slippery elm bark plus George's Aloe Drink just in case it was nausea and then offered him some random pieces of pork (his batch of food for this week is turkey). He only ate a few pieces of it, bringing his total food for the day to 145g instead of 177g. Numbers wise, that doesn't seem like a lot but the sheer amount of work and effort to get him to eat is the issue. He normally only does a circus for his before bed food and gets it with bribes (various freeze dried food) on top. For the past three weeks, every meal has been a circus and every meal has required bribes. The circus ranges from 20min to multiple hours, of him walking around to various locations only to refuse his food once more. I also have to cycle through all of the freeze dried food I have in the hopes of one of them being the correct bribe. The longer this goes on, the more bribes he refuses, and has now reached the point where none of them are acceptable. If I put his food away, he comes back to the fridge and meows for it. He's also started eating small amounts at a time, such as 20-30g at each meal instead of the normal 50-65g.

I read through the long thread about getting one's cat to eat too. I've offered ghee, and he refused. I bought nutritional yeast, he refused. Clams and clam juice, refused. Coconut oil, refused. And for some reason, meat baby food doesn't seem to exist in grocery stores or pharmacies in Canada. Cosmos has been refusing to drink the juice that goes with his food and I have no reason to believe he's touched any of the various water bowls or water fountain that I have in the apartment. He's refused the fishy water (with chunks of canned salmon in it) and the water with treats on top as well. So the only moisture he's been getting is from what his kidneys wring out of his raw food. As the result, he's gone from peeing twice a day to only once a day. Cosmos has had two instances of urinary obstruction and as usual, due to unknown causes. He's never had crystals, stones, or a UTI. I really like for him to pee twice a day to keep the mystery away, and his refusal to eat w/o all of this drama and flat out refusal to drink is surely causing stress, which I know can cause stress induced cystitis.

It's so very frustrating when he does this. It's happened before and there haven't ever been any answers. I take him to the vet and they say he's fine. Then one day he suddenly resumes eating normally. I dont know what causes him to do this, but it's exhausting and upsetting. I dont want him to have pee issues, so his refusal to drink is concerning. Plus I know that if I dont deal with his circus and desperately try to get him to eat, then he will end up becoming nauseous which will lead to an actual lack of eating. I say an actual lack of eating because he does eat SOME food, rather than literally not eating at all. It's just very stressful for him and myself when he does this. So he will be going to the vet tomorrow to check to see if anything is medically wrong. I'm going to ask them to please check his teeth as well, since I know dental issues can cause cats to not want to eat too. I brush his teeth every night, but Cosmos's body is a mystery to science so who knows. It's like he randomly decides to not thrive, which is asinine.

 

[Jabzilla]

Brief update, he'll be going to a cat specific vet tomorrow morning instead of a general clinic today. So far today he's only eaten half of his breakfast.

 

[fionasmom]

Now I am wondering if the food circus has some meaning to it beyond a game or typical cat strangeness. Doubly odd that he asks for food but has such an unwillingness to eat most of the time, especially given the amount of options that he has. Then he does eat with seemingly nothing being that different from his usual routine. It almost sounds like something happens, what that would be I don't know, and then it passes and he eats.

 

[Jabzilla]

Yeah, it's weird. There has to be some meaning or purpose behind it, especially when things get to where they are now. Where he refuses bribes outright since he knows they'll be used on his food. I'm wondering if I should seek out a cat behaviorist for help. I don't know how legitimate those are though. I ended up buying two more new bribes, both fish based, this morning. I offered his food with one of them and he seemed interested at first, but ended up refusing it. I indulged his circus for a while before putting the food away and making my own breakfast. He meowed multiples times while I was eating and as soon as I was done, he came back over and sat at the fridge. When I went to the store this morning, I bought some Blue Cat bison out of desperation. He isn't supposed to have bison since it seems to make him bloated and constipated, but neither pet store had the Big Country Raw rabbit & pork Fare Game and all of the other raw cat foods there contained chicken, beef, and/or lamb. All of which are foods he can't have. I figured bison would be the lesser of all those evils and went with that.

After finishing my breakfast, I offered him 44g of the Blue Cat bison and he ate all of it from his plate immediately, enthusiastically, and without any drama. So it's possible that he is tired of his turkey food. I dont know why he only ate a small amount of pork chop last night, since that wasn't part of his turkey batch. Assuming there's no medical reason for this behaviour, my guess is he's grown tired of the alternating batches of food that he's been on since August or so. The internal med specialist said to give him a lower fat diet, so I've been alternating between kangaroo w/ pork loin and turkey w/ rabbit on a weekly basis. Weekly food changes are normal for him and his sister since I make 7 day batches. Only having those two options though isn't. He's used to having far more food combinations than that and now that he's nearing the end of tapering off the prednisolone & free of it's compulsion to eat, I think he's tiring of those two batches of food and wants something else.

I'm going to ask about his food stuff when he sees the vet tomorrow. Because Cosmos has never had the typical food intolerance symptoms it's hard to 100% say that x food is for sure a problem. For example, I noticed that he chews on his paws more when he eats elk or venison. That wasn't always the case, and I first noticed it a few years ago when he had a batch of food containing goat and venison. I've also seen him chewing on his paws even after it's been over a month since having venison or elk. When looking at them, there isn't any damage being done to said paws either. So that's an example of a thing where I dont know if it's food related or a behavioral thing that I've noticed and now see everywhere. He hasn't had chicken in years and I stopped giving him beef and lamb in February as per the specialist's suggestion. I am afraid to even try to reintroduce those foods like you would in a proper elimination test since I dont know if removing beef/lamb played a key role in his prolapses getting better. As for chicken, that's what he was eating when he had that weird inflammation on one side of one section of his small intestine as a kitten. I dont know what caused that to happen or if chicken played a role in it. And because none of those foods would make him vomit, have diarreah, or develop itchy, inflamed skin, I'm afraid that reintroducing those foods would instead cause subtle issues that build up over time and take a while to make themselves known, like the weird red spots on his gums that randomly appeared years ago and quickly disappeared w/ the removal of beef/lamb from his diet.

I know that I am a helicopter parent with Cosmos though due to previous vets insisting he was dying as a kitten, so sometimes its hard to know if something is a real problem or if I'm just hyper focused on it. Also seeing a vet tomorrow will be an opportunity to get a third opinion on his prolapsing as well.

Sorry for writing a novel, rofl. I love this cat so much and want all to be well with him. It feels like if I just tell folks what's going on and keep searching for clues, then one day I'll somehow finally find answers, if only I search hard enough.

 

[Jabzilla]

Update: Cosmos ate his dinner without any drama. I gave him some more of that bison with his homemade turkey. He ate the former but required bribes for the latter. All 68g of food was eaten though, and he drank some juice.
I had him do a cardboard food puzzle before his meal and he participated enthusiastically since treats were involved. I don’t know if that stimulated him to eat his meal, just adding bison was enough, and/or these Vital Essentials salmon bribes happened to be acceptable today. Either way, I’m very glad and hope he will continue to eat his meals without a circus!

I tried playing with him beforehand, but he ignored the toy while his sister had a ball chasing it around. I tried the food puzzle in the hopes that it would at least get him in a hunting mood.

 

[fionasmom]

What did the vet say?

I certainly understand that you are not willing to add in food that might be a problem. Under the circumstances, I would not either as there is too much which is unknown about his reaction which could land you and Cosmos in another quandary.

My HCM/kidney boy who is 7 cycles through food preferences. I have literally ordered cases of food because he ate two cans with relish, but by can number four he was done with it. Yes, he has some medical conditions, but I firmly believe this is boredom with the same flavors.

 

[Jabzilla]

I 100% agree, Fionasmom. Boredom with flavors is definitely a thing and the idea that a cat should want to happily eat the same food every day for its entire life sounds like marketing from pet food companies more so than reality. I hear you with ordering large amounts of canned food, thinking the cat would continue liking it. When Cosmos was a kitten, I followed the vets advice and ordered a giant case of Hills D/D. He ate a can or two, but after that refused to eat more of it. Before switching to raw, he used to eat Weruva and I would buy some of every flavour they sold. And even with that wide variety in tastes, there would still be times where a can he previously loved was suddenly unacceptable.

As for today's vet visit, Cosmos was sent home with that appetite stimulant that goes in the ear. He was given a physical exam and the vet said Cosmos was uncomfortable in his abdomen. She doesn't know why and said she'd have to do lab work and an ultrasound to see if it's discomfort in the kidneys, liver, gallbladder, pancreas, or IBD. She was also very honest and said she feels out of her depth with Cosmos and that it would be better for his internal med specialist to handle it. I told her I'm scheduled to have a phone call with the IM specialist in January. Unfortunately, the specialist works at a emergency clinic so I couldn't just book an appointment with her instead of going to the Cats Only Clinic. Thankfully, the emergency clinic and Cats Only are sister facilities so the vet from today will send all of the info from this morning to Cosmos's specialist. She said in the meantime, I could give him some Gabapentin to help with the discomfort. Oh, she also said he's overweight. When measured today, he came out to 7.4kg and in September he was 6.7kg. I know weight gain is one of the side effects of prednisolone, but when I asked if the weight would come off once he's completely off the steroid or if I should reduce his calories, all the vet said was Yes and moved on. So I can try reducing his daily calories from 237, already reduced from 240, down to 230 and see how he does. The goal is for him to be 6.5kg. Earlier in the year, he was eating 220kcal per day and that made him drop down to 6.2kg. So hopefully 230kcal will be the sweet spot.

Since coming home, Cosmos has been his usual self. Playful, inspecting the groceries I brought home, meowing for food, and interacting with his sister. He ate 33g more food, for a total of 61g so far. I also gave him some Gabapentin and resumed giving him the Gut Soothe. I had stopped the latter since the Animal Biome people said not to give probiotics while doing their FMT pills. But I suspect the fact that I had temporarily stopped the Gut Soothe could be what led to this happening. It's worth noting that the food he ate was just ground turkey breast (which is his favorite and usually is what he will eat when all other food fails) and two small pieces of rabbit liver w/o any bribes. So while he was enthusiastic about eating that, he still refused the rabbit meat and duck gizzard that was offered.

I haven't given him the appetite stimulant yet, as I would like to see if resuming the Gut Soothe helps. He also isn't disinterested in eating, as he's come to sit in front of the fridge and meow multiple times. I'll give it to him if he starts refusing every food option again.

In other news, Cosmos pooped this morning and I didn't see a prolapse when he came out of the box! Here he is, relaxing with his sister post vet visit and having eaten food.

 

[fionasmom]

They are both beautiful cats and I may be reading into this, but Cosmos has that slightly displeased expression that cats get when they have to go to the vet.

If he is eating enough right now that he is not in danger of some issue from inappetence, I can see your point with waiting with the Mirataz to see if the Gut Soothe helps. I do give your vet credit for admitting that this is not her area and referring you to a specialist. This may only be some slight problem that is affecting his appetite, if anything, and discomfort on a manual exam is not that specific.

He looks wonderful, like a big healthy boy. Since you got a "yes" to both parts of the question about his weight, you might do only moderate cutting back of calories to see if the pred was mostly responsible for the weight. But he is very fluffy, so that has to be taken into consideration!

They are both lucky cats to be living such a good life with you.

 

[Jabzilla]

Thank you! I do all I can to keep them healthy and happy. Cosmos ate pretty well yesterday, as he tends to after having a vet visit. He ate all of his breakfast this morning too. I’ll continue with the Gut Soothe until his IM specialist says otherwise. He also only has seven FMT pills left, so hopefully the Gut Soothe won’t mess that up. He’s already gotten 53 out of the 60 FMT pills without any other probiotics, so getting the Gut Soothe with the least seven hopefully won’t ruin things.

About reducing his calories, how much would you say is a moderate reduction? Is going from 237 to 230kcal moderate or would it be better to reduce it more than that?

 

[Jabzilla]

Time for a Cosmos update. We had the phone consultation with his internal med specialist last week and I was very relieved that she wasn't angry or upset about the fact that I tapered him off the prednisolone. I had this (irrational?) fear that Cosmos would be made to continue taking prednisolone despite it not helping with the prolapses and gave him negative side effects. Food wise, he is eating normally (for him XD) and the circuses have been short. I've changed the way I feed him which seems to help. Rather than mixing all of the food for his weekly batch together and portioning it out into daily servings, I've made a chart with the day of the week and each meal that he gets. I then place the various ingredients in his weekly batch on the chart, making sure he doesn't get the same meat more than once a day. So far that seems to be working well since he doesn't know what he'll be getting from one meal to the next and hopefully won't get tired of the food. I still have the appetite stimulant but haven't used it. I asked the doctor about when to use it since there hasn't been a time where he's literally not eaten at all. She said I can use it if he's really being difficult about not wanting to eat. The vet then said if that doesn't work then we can try Budesonide. Thankfully there haven't been any food issues and neither medication has been needed.

As for his prolapses, they continue to happen and I think they're going to be something he just has going forward. As everything has been tried and nothing has gotten them to stop completely. He isn't a candidate for a colopexy since the prolapses are only a small section of mucosal lining, rather than all of the layers of the rectum falling out. Sometimes it resolves within 40 seconds and sometimes it takes up to 9 minutes to go back in. At this point, I dont know what causes it to be faster or slower. The consistency of his poop hasn't changed. It's still segmented, firm, and also squishable. Oh, sometimes he gets pieces of litter on the prolapse and that tends to make it take longer to go in. But aside from that, it's a mystery. I've had guesses about maybe its chicken egg yolks, blue lipped mussels, venison, or sardines, but having removed those foods didn't make a clear consistent difference. So venison and sardines have been added back into his rotation. He's done well with quail egg yolks alone so I haven't brought the chicken egg yolks back. They've proven to be just as good at preventing hairballs so I dont feel a need to return to adding chicken egg yolks. I'm still on the fence about the mussels. There's no clear evidence to suggest that leaving them out helps with the prolapsing. Sometimes its better with them in the diet and sometimes it's slow with them in there, and vice versa without the mussels. December was one of his best months for the prolapses since the vast majority of them consistently resolved in about 40 seconds or so. Why that is though remains a mystery. January has been far more variable, with prolapsing resolving in anywhere from 45 seconds to almost 10 min. One day the prolapse resolves in 3 min, 30 seconds the next day, 9.5 min the following day, and then 40 seconds on the next.

Speaking of the Gut Restore, Cosmos's specialist was interested in his Animal Biome report and urged me to have another sample tested now that he's finished his 60 day Gut Restore course. So I'm working on getting a fecal sample from him sent out today.

Weight wise, the vet said to try reducing his daily calories by 20%. I asked what she thinks his weight should be, but she said thats hard to say since different weights work best on different cats. She guessed maybe 6kg (he was 7.4kg when weighed in late December). I think 6.5kg is good for him since thats what his weight had been for years prior to all of this happening. I also feel like a 20% reduction is a lot. He's already had his calories reduced by 5% so for his batch for this week I've reduced it by another 5% for a total of 10% reduction. We'll see how he does with that.

Oh, the specialist said to try adding Adored Beast Healthy Gut to his routine. I've ordered a container of it but I'm not sure what it's supposed to do for him since he doesn't have diarrhea, unintended weight loss or vomiting. So I don't know what would indicate that he would need things like the digestive enzymes in Healthy Gut. It won't hurt him though, so I figure I can try it and see what happens. He still gets the Gut Soothe and Fish Oil.

Overall, Cosmos continues to be well. He's active, playing, eating his food, and has recently returned to peeing twice a day instead of holding it and peeing once. It looks like the fur has finally started to grow back on his ears too. <3 More fur than normal comes out when I brush him, but hopefully that will stop soon since he's no longer on the prednisolone.

 

[fionasmom]

Regarding the pred, you are probably at a point with the vets where they trust your observations and appreciate how vigilant you are. Remember that these doctors also have to deal with patients who are only marginally on top of what goes on, even if they have good intentions about their cats.

The pattern to the prolapses may just be the way that they are, which is not much of an answer, but if the stool remains consistent throughout is seems that it is not exactly food related? If it went from hard to soft, depending on food, I could see that but this is so subtle that it is hard to figure.

Overall, Cosmos continues to be well. He's active, playing, eating his food, and has recently returned to peeing twice a day