Repeating Rectal Prolapse

[Jabzilla]

Hey folks,
Time for a quick Cosmos update. He pooped on Friday without producing a visible prolapse! Aside from that time, his other prolapses have been resolving in 30-90 seconds. They're still small like the picture shared last month. Cosmos has been taking the higher 10mg dose of prednisolone since Sept 14th and the only change has been the more consistent prolapse resolution within a minute or less. Looking at his prolapse tracking sheet, the ones prior to 9/14 were resolving in roughly 1.5 to 3 minutes. Cosmos has also been getting one KittyBiome™ GMP – AnimalBiome capsule each morning since 9/26. He has been off the marbofloxacin since 9/14 per the specialists instructions, which I found odd since the histology report said there was heavy e coli in the results. It's excellent that the FISH test showed the bacteria wasn't infiltrating the lining of his colon, but the overgrowth is still there in the lumen. So I ordered the Kitty GMP in hopes of it helping to fight off the e coli overgrowth without negatively impacting the rest of his gut flora. He's still getting fish oil twice a day, the Adored Beast Gut Soothe, S Boulardii, Renew Life Probiotics, and now also 1/8 tsp of FOS to help feed his good gut bacteria after seven months of daily bombardment with Marbofloxacin. Cosmos is doing well as always, but his playfulness is still dampened by the prednisolone. I'll be glad when he no longer has to take it!

 

[fionasmom]

Thank you, as always, for the update! This is very good news that the earlier prolapses resolved quickly and now he has not even had one. He must be so much more comfortable and happy, even if the pred does have an effect on him. Here is hoping that you are on the road to complete recovery.

 

[Jabzilla]

Hey folks,
Time for a brief update. Cosmos continues to do well. Nothing much has changed in terms of his prolapses. They're still small and go back in on their own. He's still on the 10mg dose of Prednisolone and I'm not happy about that. He's been on a low anti inflammatory dose since July and that was increased to 10mg once a day in September. Nothing has really changed during that time in terms of his prolapses. They were already small before the increased dose and they still happen. Meanwhile, he's starting to get chunky, he still doesn't want to play, and the fur on his ears has thinned to the point where its possible to see the skin underneath. I dont feel like the prednisolone is doing anything positive for him. His colonoscopy showed only mild inflammation in random spots of his colon with the rest being normal. Back in January, his ultrasound showed his entire colon was inflammed. All of that improvement from Jan to July was made without the use of steroids, so it's odd that three months of them hasn't stopped the prolapsing entirely. That makes me feel like Prednisolone probably isn't the right answer and I am afraid of the fact that it can cause diabetes, liver damage, etc.

I'm supposed to have a check in with the specialist in a few weeks and I want to tell her that I dont want him to continue to have to take steroids. In the meantime, I'm thinking of trying the Gut Restore FMT pills from Animal Biome. He doesn't have any issues with diarrhea, vomiting, or constipation, so I'm not sure if they'll provide much benefit. But I figure they at least wont cause him harm, unlike the prednisolone.

 

[gizzieblue]

Hi -sorry to hear that there are no more improvements. I honestly think you should try the supplement I've got for Mango - he didn't have any more prolapses since and he's doing really well. From 2" bright red went to normal in few days [ and he went missing for 5 days! ], than he had just maybe 1/4" tan colored the following week, and nothing since than. He happily eats the raw food I make [ none of my cats tolerated ever psyllium, so I add very very little cellulose - bad, but at least not viscous ] and at 13, he catches these fat rats - comes with them by my feet!
10mg pred is a lot. But I taught the im was going to switch to budesonide? Diabetes, yeah ... but cushings, that's even worse. In any case, make sure you tapper the dose. Maybe add some antioxidants.

I honestly think you should try that supplement - it's only $30, i think you can even return it. You cannot imagine the poor shape Mango was in - and no way to take him to the vet [ he was not eating ]. I think all in all I gave the pills for 2 weeks, once a day [ he only shows up at nighttime ] .

Weird, but it appears that some ppl my be allergic to psyllium? Maybe switch that to something else?

 

[fionasmom]

Definitely discuss the use of the pred with your vet. He may be at a point where the risks of continuing it are outweighing any benefits that may have been there at one time.

 

[Jabzilla]

Thank you Gizzieblue and Fionasmom. I've emailed the specialist about my concerns with prednisolone and asking if we can start tapering him off of it. Previously when I asked her about switching to budesonide she simply said no and that she wants to stick to Prednisolone. No reason for why was given. I brought it up again in my email from this morning, asking if he can be switched to it if she really feels like he needs to be on a steroid. I also asked her if she thinks it would be worthwhile trying the Animal Biome FMT supplements.

I've looked at the Best4Life supplement that you told me about Gizzieblue, but I am way of trying homeopathic remedies again. Cosmos used to have a homeopathic vet who used to be a conventional one and switched to that. I dont know if any of the remedies she gave him ever worked. Though the longer this goes on without resolving completely, combined with all of the test results for everything being negative, it makes me wonder if I should try it anyway. As for the psyllium husk, I've reduced his weekly amount from 5g to 2g. That's resulted in smaller poop which helps the prolapses to go back in faster. I can try leaving it out entirely when I make the next weekly batch of food for him on Sunday.

I'm glad to hear that Mango has had such a wonderful improvement! <3

 

[Jabzilla]

Also, I never posted a photo of him that wasn't of his butt, lmao. Have some with his face in them.

 

[fionasmom]

He is a beautiful boy and looks just gorgeous. That is a huge coat! Tell him we are all happy to see his other end finally.

 

[mrsgreenjeens]

He's gorgeous!!!

 

[Jabzilla]

Thank you <3 Lol, I'll be sure to let him know!

 

[Jabzilla]

No visible prolapse today! <3 His specialist hasn't responded to my email about tapering him off the prednisolone. But the Animal Biome test and FMT pills have arrived. I'll collect a sample for the test tomorrow evening, since it said to stop probiotics for 24 hours before getting a sample for it. And since there's no rush, I'll start him on the FMT capsules after his results come in. Hopefully I'll have heard from his vet by then.

 

[gizzieblue]

Sorry, I'm in a rush: make sure to let animal biome that he is immunosuppresed - 10mg pred is a high dose and by what you described, I'd say he is. In some cases, even probiotics can cause problems in immunosupressed ppl. Not to scare you, but make sure you discuss this w/animal biome - plenty of cats taking fmt pills on prednisolone.

But really weird that she's not switching to budesonide. B is better imo. Psyllium: I'll see if I can find the info I saved. Seems that our cats have the same problem w/miralax and lactulose ...

How are his gums / breath? [ breath i bet it's cleaned ]. You can get the urine sticks to check for glucose in urine. I know cats on high pred doses [ for scl or ibd ] that are given liver support meds and are doing well. I gave milk thrisle and 440 to my diabetic kitty, but he never did well on immunosuppressive meds, he had entero invasive e coli. Cats do get steroid-induced hepatopathy, even if uncommon. I'll msg later some fmt stuff.

Oh and yes, he's gorgeous and he knows it!

 

[Jabzilla]

Ohhhh, thats a great point Gizzieblue, thank you! I'll make a note to remind myself to tell the Animal Biome folks about Cosmos's dose of prednisolone and ask if there would be any issues with taking the FMT pills in regard to being immunosuppressed. Thankfully, I dont think Cosmos has the damaging side effects that I listed. I'm just afraid of him getting them in the future from the Pred. If I don't hear from his doctor, I'm going to just taper him off of it myself. I've looked up a bunch of info on safe tapering schedules and have that as a plan b, as the vet not responding to my emails has been a problem. As for Cosmos's breath and teeth, they're both good. I brush his teeth every night before going to bed. His batch of food for this week doesn't have any psyllium in it, and so far there hasn't been a negative effect from leaving it out.

 

[Jabzilla]

I finally got a response from the specialist's assistant. She wants to keep Cosmos on the 10mg dose of Prednisolone for 6-9 months since the prolapsing hasn't stopped. The email says his organs are tolerating it since his bloodwork was good. But that bloodwork was done when he was taking the significantly lower .5ml a day dose. Again, no answer was given about budesonide for some reason. I know there are cats who are on pred for years. Is 6-9 months at 10mg a long time and a high dose? I really dont want him to be harmed and all of the websites just say the bad side effects happen from long term use at high doses. None actually give any clue as to what long term and/or high dosages consist of. Cosmos weighs 6.8kg, for reference. I saw a website say the immunosuppressive dose is 2-6mg per kg for cats, so 10mg is a little less than that. Is one month a reasonable time for 10mg of pred to show clear results? Nothing has changed in terms of his prolapse between using .5ml of pred and increasing it to 10mg. If prednisolone is the correct fit, doesn't it cause some kind of immediate positive result?

 

[Jabzilla]

The more I think about it, the worse I feel about Cosmos’s doctor’s decision. I don’t like the idea of blatantly refusing to do what a vet says, but this time it feels like the right thing to do. I’m not going to have him on steroids for 6-9 months. That seems quite excessive and like a mistake. She’s already had him taking Marbofloxacin unknowingly needlessly for over 7 months before finally getting the FISH test, only to learn Cosmos does not have the granulomatous colitis that she expected. The improvements to Cosmos’s prolapse have happened without steroids and there hasn’t been much change since starting them. The medication is making him feel like he’s starving all the time, has caused him to become overweight, is thinning the fur on his ears, and has taken away his desire to play. All of those things impact his life more than the prolapses do.

I’m going to stick to my plan. His poop sample was sent to Animal Biome yesterday and I’ll slowly taper Cosmos off the prednisolone with three weeks between each dose reduction, then 2.5mg every other day for three weeks, and then 2.5mg every third day for three weeks, then done. Once the microbiome test results come in, I’ll start him on the gut restore.

I’ll include the photo I tried to grab of his bottom after he pooped this evening. It’s hard to see, but it’s so much better than the swollen, bleeding, angry red, donut-Esq mass that he had back in January.

 

[mrsgreenjeens]

Sometimes you just need to go with your gut feeling. IF things start going backwards, you can always put him on the full dose again, I suppose. But we're not thinking that way. Things will go great!

 

[Jabzilla]

Thank you Mrsgreenjeens. I've read almost every thread on here about IBD and prednisolone and almost every cat that's taking it is on far less than 10mg a day and said cats had been vomitting, diarreah, weight loss, thickened intestines, nausea, etc without (and in some cases with) it. Cosmos has none of those things and I haven't found anything that says rectal prolapse is a symptom of IBD. I feel like the vet has just come to the IBD conclusion because all of the tests have been negative and she doesn't know what else it could be. And even if it is IBD, I still dont understand why he would need to be on such a high dose for such a long time when cats who are very sick, even some with cancer, are taking less than 10mg of steroids a day.

This is reminding me of when Cosmos was a kitten and he had inflammation on one side of one section of his small intestine after eating the """""""hypoallergenic"""""""" Royal Canin kibble that his vet at the time needlessly pushed onto us. I figured feeding him that must be right since thats what the vet said to do, despite Cosmos not having a problem and the vet not saying why he wanted him on that food. Seven days later he was in the hospital due to being unable to pass the food he had eaten. He had an ultrasound which revealed that odd inflammation in his small intestine. The specialists at the hospital INSISTED he had FIP and told me Cosmos was dying. I asked if it could be lymphoma, and I asked if it could be IBD. The vet said no to both and again insisted it was FIP. No testing or anything was done to try to confirm or rule out FIP. That conclusion was based purely on the ultrasound. No steroids or any other medication was given. The hospital staff sent Cosmos home after a few days once he was stable and the food had finally passed from his body. The vet gave him two months max to live. During that time, Cosmos was literally fine. I watched him like a hawk, trying to find signs of his impending fading away and death, none came.

I switched him and his sister to raw food, and the weird inflammation in his small intestine went away on its own. That was over five years ago. The desire to place him on 10mg of pred for 6-9 months sounds like another instance of a vet being confused by his seemingly inexplicable body and coming to a drastic conclusion w/o any supporting evidence.

It's hard feeling like doctors are unable to help with an issue. But I'm not making the mistake of blinding following advice just because a vet said it again. Like you said Mrsgreenjeens, if Cosmos's prolapses suddenly become worse I can increase his dose of pred or put him back on it if it happens once he's finished tapering off of it. Its very unlikely for that to happen, given all of the recovery has happened w/o steroids. Thank you for your support and I agree, things will go great as Cosmos continues to be well and his prolapses decreasing.

 

[Jabzilla]

Alrighty, Cosmos' microbiome test results came in so its time for another update! He's doing well. The prolapsing still happens and it still resolves quickly on its own. I'm very glad I did the microbiome test, as it turns out, he's missing over 20 different families of gut bacteria! Taking marbofloxacin really did a number on his system and if he hadn't been taking probiotics along side it, Cosmos wouldn't have had hardly any gut bacteria left. I have a phone consultation w/ Animal Biome tomorrow to go over his results. Based on their description, a lot of the missing bacteria serve an anti inflammatory and immune system regulatory function. Clostridium Perf. is still there apparently, but in small and acceptable amounts. E Coli has dropped way down and Enterococcus is gone. Cosmos has a very high amount of Bifidobacterium and Streptococcus which would be from the Adored Beast Gut Soothe and the Renew Probiotics he'd been taking. I'm planning on asking AnimalBiome about stopping the Gut Soothe for now since the bacteria from it has gotten so high.

It's interesting that the families of bacteria that are high in cats with IBD are entirely absent in Cosmos. I'm going to ask about that as well. As for now though, that sounds like more support for my theory that he does not have IBD and that diagnosis was settled on due to not knowing what else it could be. Based on the results from the PCR test in December, the histology from the colonoscopy, and the FISH test, it sounds like Cosmos had an over growth of C Perf and while fighting that, a heavy over abundance of E Coli and Enterococcus took over. And the 7 months of Marbofloxacin use wiped out everything else. I am hoping that once Cosmos has those missing bacteria from the Gut Restore, they will heal any remaining spots of mild inflammation that he might have and fingers crossed, finally stop the prolapsing.

 

[Jabzilla]

Hey folks,
Cosmos has almost finished the first of two 30 day courses of Gut Restore, so I figured I'd provide an update. He usually gets one capsule of it a day, but there have been some days when he got 2 a day. The person at Animal Biome recommended giving him 2 per day for a total of 60 capsules since his microbiome was missing so much beneficial bacteria. I haven't given him 2 per day every day since I dont want to possibly cause digestive upset. He's been doing very well with it so far. His poops have gone from very dry segmented logs to easily squishable segmented logs. For some reason neither of my cats have ever had the dry crumbly poops that folks have reported from raw feeding. Anyway, from what I've seen, they're requiring less effort on his part to push them out too. He's never been one to strain like what you see when you look up "cat straining in litter box/to poop", but I had noticed that he would take a bit longer to push his out and would sometimes sway a little while doing it. While his sister, Rocket, doesn't do any of that and her poops come out easily and quickly. So I'm quite pleased to report that the Gut Restore is helping with that.

At first I was worried about him not being able to take the Adored Beast Gut Soothe while doing the Gut Restore. (all probiotics are to be stopped while doing the FMT pills) Thankfully there hasn't been any sign of issues from not having the Gut Soothe though. He shouldn't even need it since he's been on Prednisolone since July, so there shouldn't even be anymore inflammation to soothe. Speaking of steroids, he's down to taking 2.5mg a day and has one more week of that before tapering it to every other day. Since lowering the dose, Cosmos no longer acts like he's desperately starving and he's slowly becoming more playful. He isn't sleeping all day either. <3 Oh, and he no longer takes the Gabapentin! He hasn't had any of that since 11/17 and his prolapses have still been resolving quickly on their own without it. In fact, I replaced giving him Gabapentin with his mid morning snack with giving him a Gut Restore capsule instead. So currently, all he's getting with his food is the 1ml of fish oil twice a day, 1/2 S Boulardii twice a day, the Gut Restore 1-2 times a day, and his tapered Prednisolone before bed.

It's so nice to see his personality starting to come back! <3 Rofl, unfortunately, the food circus has also returned. XD I remember that he had stopped doing the circus back in June and early July before starting the Prednisolone and he was also actively playing with his spring toy each day. I highly suspect that his food circus is seen as a game to him, as he always makes sure I'm following him around with his food and he's vibrating his tail while doing it. I am hoping that once he's fully off the steroids, he will return to actively playing with his toys and will immediately eat his food in the kitchen, rather than engaging in the circus.

I don't remember if I spoke about the circus on here before. In case I hadn't, the Cosmos circus involves him asking for food and then wandering to a random spot in the apartment, expecting me to follow w/ his plate of food in hand. He will then sit in said spot and want me to place a piece of food on a surface. Be it a box, a table, a chair, etc, so he can then playfully pull the piece of food down onto the floor and then eat it. This has been an ongoing thing for years and I try to resist indulging in it. Sometimes if he leaves, I put his food away, which then results in him coming back and meowing for it again. Sometimes that results in back and forth of him leaving, me putting it away, him coming back and meowing for it again, etc. Sometimes he will come back and eat his food after just one round of that back and forth. And then other times, he will get frustrated with me not engaging with his circus and will go lay down in his muffin tin (cat tree). Folks have said to not even do that and just put his food away until the next meal if he tries to do a circus. But I am very wary of that because I know he gets nauseas if he doesn't eat, which then leads to more not eating.

Anyway, I was able to get him to stop doing the circus before starting steroids, so that shows its possible to do it again. Fingers crossed that regaining his normal level of playfulness and actually playing (instead of lazily watching) once the Prednisolone is over will also result in the abolition of the circus.

 

[fionasmom]

Thank you for letting us know that things are looking good for Cosmos. You deserve a huge amount of credit for all that you have done to get him to this point. The food circus sounds like it is partly one of these games that cats get into with wanting specific rituals for certain things. Having said that, I can see that it would be irritating to keep this up for weeks on end and I hope that you can get him back to schedule.