Still has chronic diarrhea after treatment

[Sillycat41]

I've posted here before about my 18 yr old Jengo who has CKD and IBD. He was constipated for a long time until May 2024 when he started having some softer stools. This progressed to partially formed chunks surrounded by soft stool. It kept getting worse... setting softer and softer with some lumps. Then in July there was watery diarrhea around the lumps. Occasionally there was bright red blood in some of the stools. Sorry about the graphic description.

An in-house labs test didn't detect anything so the vet sent a sample out for a PCR test. The results were that he has Clostridium Perfringens so the vet put him on Tylan (Tylosin) twice a day in early July. This med had very little effect... sometimes his stool was a little firmer but still diarrhea. Since he has IBD the vet switched him from Prednisolone to Budesonide for the irritation in the intestine. Since the Tylan didn't seem to be working the vet said to discontinue it.

I did some research online and found that some people used S. Boulardii to stop the diarrhea. I got some Jarrow brand with MOS and started giving that to him but saw very little change in his stools. I also tried adding psyllium... not much change with that either. I also read that some people have had luck with Metronidazole so I wrote to the vets today to see if we can try that drug. His regular vet is currently on vacation for 2 weeks and the other vets didn't call me back yet.

I started thinking about the fact that he has lumps of formed stool and watery diarrhea around it and I'm wondering if he might have a tumor (lymphoma) causing the stool not to form and the liquid to seep around it. Does anyone know if this makes sense? I'm very worried about him. He still has and appetite and seems somewhat okay, but he had a lot of gurgling sounds in his intestines that I can sometimes hear from across the room.

I would appreciate any comments. I feel like precious time is running out... this chronic diarrhea has to be stopped!
Thanks in advance. Barb

 

[FeebysOwner]

Hi. Some of the PCR tests will also include identification of the type of Clostridium Perfringens that is involved, and that can play a role in treatment/level of complexity in treatment. Give the Metro a try, but it, like many antibiotics, can also attribute to diarrhea.

Has he had a recent ultrasound to see the condition of his intestines? CP can be secondary to other problems and may not completely respond to antibiotics. Has the vet mentioned anything about these aspects?

 

[mrsgreenjeens]

With his many issues, has he had a recent ultra sound? And did you ever try the Slippery Elm Bark recommended? I know we are throwing ideas at you left and right, and sometimes too many changes throw their intestines into turmoil, but have to ask anyway? Is he still better when you just give him poached chicken?

Oops, was responding at the same time as FeebysOwner , as we both asked about the Ultra Sound

 

[Sillycat41]

Hi. Some of the PCR tests will also include identification of the type of Clostridium Perfringens that is involved, and that can play a role in treatment/level of complexity in treatment. Give the Metro a try, but it, like many antibiotics, can also attribute to diarrhea.

Has he had a recent ultrasound to see the condition of his intestines? CP can be secondary to other problems and may not completely respond to antibiotics. Has the vet mentioned anything about these aspects?

Yes the PCR test said it was "C. perfringens Alpha Toxin (CPA) Gene" - high levels of CPA gene. I'm still waiting to hear from the vet. This is so frustrating because they are busy and it takes so long for them to get back. In the meantime Jengo is suffering and so am I. Wish we had an ER vet clinic here.

So it the anti-biotics can cause diarrhea, how can it be stopped??

He probably should have had an ultra-sound but his vet is the one who does them and is on vacation now. I'm afraid of what the results will be... like lymphoma. I read somewhere that IBD can turn into lymphoma. I'm very worried and stressed.

 

[Sillycat41]

With his many issues, has he had a recent ultra sound? And did you ever try the Slippery Elm Bark recommended? I know we are throwing ideas at you left and right, and sometimes too many changes throw their intestines into turmoil, but have to ask anyway? Is he still better when you just give him poached chicken?

Oops, was responding at the same time as FeebysOwner , as we both asked about the Ultra Sound

No he hasn't had an ultrasound recently. The vet who does them is on vacation now. I did try Slipper Elm Bark for a couple of days, but I have been adding so many things to his food that I backed off. He eats every 3 hours so adding things in between meals keeps me busy. Like you said, maybe I'm making too many changes in a short time. He does like poached chicken so I'm syringe feeding him chicken baby food along with his regular foods. I wonder if his food could be causing diarrhea now. So many things to think about. :-(

 

[FeebysOwner]

So it the anti-biotics can cause diarrhea, how can it be stopped??

Many folks give s. boulardii. It is a yeast based probiotic, so it isn't killed off like most probiotics. The goal of antibiotics is to eradicate bacteria causing an infection, however they are indiscriminate, so they kill off both good and bad bacteria. S. boulardii helps to restore the good bacteria, which in turn can reduce antibiotic induced diarrhea. I am sure it doesn't work for every cat. Here is data on how to use s. boulardii to stop diarrhea from a raw feeding website - but it isn't only applicable to cats who are on a raw diet.
How to Use S boulardii for diarrhea - Raw Feeding for IBD Cats

 

[Sillycat41]

Many folks give s. boulardii. It is a yeast based probiotic, so it isn't killed off like most probiotics. The goal of antibiotics is to eradicate bacteria causing an infection, however they are indiscriminate, so they kill off both good and bad bacteria. S. boulardii helps to restore the good bacteria, which in turn can reduce antibiotic induced diarrhea. I am sure it doesn't work for every cat. Here is data on how to use s. boulardii to stop diarrhea from a raw feeding website - but it isn't only applicable to cats who are on a raw diet.
How to Use S boulardii for diarrhea - Raw Feeding for IBD Cats

Thanks. I think I read that article before but will read it again. I just called the vet clinic again and broke down crying. I haven't cried about anything in ages, but I'm so afraid that I am losing Jengo because the chronic diarrhea has been going on so long unresolved and I can't get any help. I'm sure that he isn't getting enough nutrients from his food since it passed right thru. I was told that I could bring him in on an emergency call for $225. I don't see why this is necessary since he is already being seen for this problem with the vet who is on vacation. I would think it is just necessary to prescribe a different antibiotic. See him isn't going make any different. He recently had blood work and the PCR test. I'm so upset. Thanks for letting me vent. Barb

 

[Jabzilla]

Hey, have you tried the Animal Biome Gut Restore FMT capsules? How Is Diarrhea Connected to Your Cat’s Gut Health? - KittyBiome Since your cat has been on antibiotics and the diarrhea is still on going, I would definitely give them a try. Rather than just wiping out the Clostridium Perf, those antibiotics also kill off the good bacteria, which leads to diarrhea. KittyBiome™ Gut Restore Supplement – AnimalBiome The Gut Restore will bring back the good bacteria that's been killed off and/or was missing and will push the Clostridium back into its proper amount, as some C. perf is normal in a healthy gut. It becomes a problem when the gut becomes unbalanced and the C. Perf over grows. I highly recommend doing a course of Gut Restore. It's the only way to get all of the healthy cat specific bacteria back into your cats system. Probiotics are good, but if you read the names of what's in them, you'll see the same names over and over again. The lacto and bifido classes of bacteria are FAR from the only ones found in a healthy feline microbiome and so far FMT pills are the only way we have to restore the ones that are missing.

Also from their page on diarrhea: "

Many prescribed veterinary medications may cause diarrhea as a side effect, including steroids, non-steroidal anti-inflammatory drugs (NSAIDs), heart medications, bronchodilators (for asthma), and anti-anxiety drugs. But the most common diarrhea-causing medications are antibiotics, which disrupt the gut microbiome by killing off a lot of beneficial bacteria along with the pathogens they’re meant to target.

Metronidazole (Flagyl) is an antibiotic and antiprotozoal medication that’s frequently prescribed for cats—for example, to treat gum disease, bacterial infection, and even unexplained diarrhea. But this particular drug has been found to cause long-term damage to the gut microbiome, and is less effective for many GI conditions than previously thought."

I know in my experience, every time my cat was given Metronidazole for any reason it ALWAYS gave him diarrhea. Every single time. The vets always say its supposed to stop diarreah, but for my cat it always caused it where there was none before. So if a vet tries to give him Metro, I tell them no.

Cat Diarrhea: What Owners Can Do To Help And When To Seek Veterinary Care - KittyBiome

 

[Sillycat41]

Hey, have you tried the Animal Biome Gut Restore FMT capsules? How Is Diarrhea Connected to Your Cat’s Gut Health? - KittyBiome Since your cat has been on antibiotics and the diarrhea is still on going, I would definitely give them a try. Rather than just wiping out the Clostridium Perf, those antibiotics also kill off the good bacteria, which leads to diarrhea. KittyBiome™ Gut Restore Supplement – AnimalBiome The Gut Restore will bring back the good bacteria that's been killed off and/or was missing and will push the Clostridium back into its proper amount, as some C. perf is normal in a healthy gut. It becomes a problem when the gut becomes unbalanced and the C. Perf over grows. I highly recommend doing a course of Gut Restore. It's the only way to get all of the healthy cat specific bacteria back into your cats system. Probiotics are good, but if you read the names of what's in them, you'll see the same names over and over again. The lacto and bifido classes of bacteria are FAR from the only ones found in a healthy feline microbiome and so far FMT pills are the only way we have to restore the ones that are missing.

Also from their page on diarrhea: "

Many prescribed veterinary medications may cause diarrhea as a side effect, including steroids, non-steroidal anti-inflammatory drugs (NSAIDs), heart medications, bronchodilators (for asthma), and anti-anxiety drugs. But the most common diarrhea-causing medications are antibiotics, which disrupt the gut microbiome by killing off a lot of beneficial bacteria along with the pathogens they’re meant to target.

Metronidazole (Flagyl) is an antibiotic and antiprotozoal medication that’s frequently prescribed for cats—for example, to treat gum disease, bacterial infection, and even unexplained diarrhea. But this particular drug has been found to cause long-term damage to the gut microbiome, and is less effective for many GI conditions than previously thought."

I know in my experience, every time my cat was given Metronidazole for any reason it ALWAYS gave him diarrhea. Every single time. The vets always say its supposed to stop diarreah, but for my cat it always caused it where there was none before. So if a vet tries to give him Metro, I tell them no.

Cat Diarrhea: What Owners Can Do To Help And When To Seek Veterinary Care - KittyBiome

Thanks for responding. Never heard of KittyBiome Gut Restore. Thanks for the links... I'll check it out. How come vets don't recommend this? My vet just said to give him Proviable but I hasn't none anything.

Jengo wasn't on any anti-biotics when the diarrhea started two months ago... he was constipated before it started. He tested positive for Clostridium Perfringens (high) so the vet put him on Tylan but it didn't seem to help, Now the vet is going to try Metronidazole. After reading your experience with this drug, now I'm afraid that it will make things worse. :-(

Does the fact that he has kidney disease have anything to do with this? The vet keeps reminding me of that. I just assumed it was causes by the bacteria in his intestines. I am desparate to get this diarrhea under contol since it's been almost 2 months now and he has lost weight. I'm very worried.

 

[Jabzilla]

Thanks for responding. Never heard of KittyBiome Gut Restore. Thanks for the links... I'll check it out. How come vets don't recommend this? My vet just said to give him Proviable but I hasn't none anything.

Jengo wasn't on any anti-biotics when the diarrhea started two months ago... he was constipated before it started. He tested positive for Clostridium Perfringens (high) so the vet put him on Tylan but it didn't seem to help, Now the vet is going to try Metronidazole. After reading your experience with this drug, now I'm afraid that it will make things worse. :-(

Does the fact that he has kidney disease have anything to do with this? The vet keeps reminding me of that. I just assumed it was causes by the bacteria in his intestines. I am desparate to get this diarrhea under contol since it's been almost 2 months now and he has lost weight. I'm very worried.

You’re welcome. I think a lot of vets don’t recommend Animal Biome because they simply don’t know about it. It’s relatively new, and as such, isn’t taught about in Vetrinary school. Whereas companies like Hills, Royal Canin, and Purina regularly give presentations at Vetrinary schools and are heavily embedded in the programming there. The use of standard drugs is also taught in schools as well. That’s why we hear the same ones over and over again, Metronidazole, Prednisolone, Tylosin, etc.

In order for a vet to know about Animal Biome, they have to be actively seeking out new information and treatments as part of a continuing education after school, and not all of them do that. One of the older vets who saw my cat for his prolapses didn’t know what S Boulardii was and laughed at me for using it. Whereas the internal medicine specialist that he now sees is the one who told me to continue the S Boulardii, put him on fish oil and Adored Beast Gut Soothe, and was in favour of doing the Animal Biome gut test and their Gut Restore. She’s a younger vet and regularly attends conferences and keeps up with new developments in the field. So it depends on the vet as to whether they know about Animal Biome.

Feel free to introduce your vet to it if they haven’t heard of it. Animal Biome has a page specifically for vets on their site.

 

[Sillycat41]

Wanted to post an update and ask a few more question on this subject. Should I start a new thread or just continue on this one. Please advise. Thanks. Barb

 

[FeebysOwner]

If you are asking me, I'd say just continue to post here since it is on the same subject.

 

[Sillycat41]

If you are asking me, I'd say just continue to post here since it is on the same subject.

Okay thanks FeebysOwner. I'm depressed and frustrated. Took Jengo to the vet yesterday for a routine blood test and thyroid test which is sent out. Holiday weekend so won't get results til next week.

Good news: his chronic diarrhea that has latest 2+ moths is getting better. He is having formed stools now and just some soft or diarrhea in between. The problem is that it's hard to tell what is working because he's on different things... first anti-biotic was Tylosin which didn't work then switched to Metronidazole which seem to work. However I have also been giving him Endosorb, Jarrow S. Boulardii with MOS, bentonite clay and some slippery elm. It seems like a lot but I don't know which one to cut back on.

Bad news: I just rec'd the blood test results a few minutes ago and I'm devastated.

June 28th results:
BUN 68.3
Creatinine 3.8
Phophorus 4.8

Aug. 29th results:
BUN 76.7
Creatinine 4.2
Phosphorus 7.0
with other values off slightly

I'm wondering if the kidney numbers got worse in 2 months because of the chronic diarrhea or because of the medications damaging his kidneys even more???? All drugs have side effects... did this diarrhea push him over the edge??? Is there anything I can do to help him or is it too late?? I'm devastated... would appreciate any advic or comments on your experiences. Thanks in advance.

 

[stephanietx]

Any time your kitty is in stress, the kidney numbers will show that. The diarrhea didn't push him over the edge. With so many various issues going on in your kitty, the kidneys are going to be stressed. His BUN and Creatinine are actually lower. Phosphorus could be because of food change. What was his potassium? We give our CKD girl a potassium supplement daily.

 

[FeebysOwner]

Have you talked with the vet about all the stuff you are giving him and about the blood work results? Besides all of the things to try to curb the diarrhea, what else is he currently taking?

Have you been doing anything to counteract the CKD? I am not familiar with anything you are giving him that would worsen his CKD, nor do I think diarrhea would cause it either. However, dehydration can cause elevated kidney numbers, especially BUN. So can stress.
Even some cats with a creatinine of 3.8, much less 4.2, get routine sub-Q fluids at home.

Is Jengo still eating well? Losing weight? Usually cats with his numbers tend to be a bit inappetent. His phosphorus is also high enough to be treated, either with renal foods or with a phosphorus binder. With IBD, some cats get B-12 injections to help with food absorption in the bowel. A cobalamin (B-12) blood test can be run to find if his is low - although it is possible the loose stools aren't helping matters any.

Is your regular vet back now? I think all of this needs to be discussed with them - at length, including the ultrasound. I would think he needs to come off some of the anti-diarrheal aids - it just sounds like way too much.

stephanietx - you have the dates backward, his kidney numbers have increased.

 

[Sillycat41]

Any time your kitty is in stress, the kidney numbers will show that. The diarrhea didn't push him over the edge. With so many various issues going on in your kitty, the kidneys are going to be stressed. His BUN and Creatinine are actually lower. Phosphorus could be because of food change. What was his potassium? We give our CKD girl a potassium supplement daily.

He is definitely stressed when I take him to the vet, but he always is and yet this kidney numbers keep going up. They did actually go up from June to Aug. I found out that a new food I've been feeding him has higher phosphorus so I should have increased his phosphate binder. His potassium was in the normal range... 3.9 (normal listed as 3.4 to 5.3). I have been wondering if he needs more potassium since weakness can be caused by low potassium. How much do you give your kitty daily?

 

[F+V]

You might also want to see SDMA level for his kidney disease in addition to Creatinine and BUN levels. Repeated overuse of antibiotics should be avoided and some antibiotics including metronidazole are hard on kidneys, especially CKD patients. They could also cause diarrhea. My boy had been on an antibiotic for 13 days and had diarrhea every single day despite taking an antidiarrhea med, and s.boulardii wasn't effective in stopping the antibiotic-associated diarrhea.
With his persistent diarrhea he must be severely dehydrated, which is also bad for his kidneys.

I'd also suggest ultrasound, and also have a look at kitty biome J Jabzilla suggested. Can you give him a little bit of water with a syringe without a needle or a small spoon for the time being till you see the vet? Like FeebysOwner says, he needs sub-Q fluids.
For high phos, you can use phos binder or cooked egg white added to his food. And never limit protein intake, even though many older vets suggest otherwise. Use of ACE inhibitors like benazepril which is a blood pressure lowering med is beneficial for CKD cats. I've also read that regardless of blood pressure level, combine with amlodipine helps.
And once fluid flow through kidneys is increased, you can discuss your vet about loss of potassium and water-soluble B vitamins.

 

[F+V]

As for potassium, unless blood test showed he was low, I wouldn't give him yet. Electrolytes are usually an add-on to a normal blood test.

 

[FriendofFerals]

Ok, I've actually had giardia myself thanks to a job that required frequent trips to Venezuela where I got it even aftern taking every precaution...I needed three rounds of Flagyl and then another two rounds a year later when "dormant eggs" hatched thanks to a stressful event. I have a former feral cat who had a very bad whipworm infection and somehow he beat the parasite only to have "dormant eggs" also go active after he'd been indoors for a year and after a full mouth extraction (stressful event). I can tell you this is what set off his current "IBS/IBD" and my own.

It takes a WHILE for intestinal inflammation from a parasite infection to subside. Long after the cause is gone. Flagyl is a harsh medication but it does work to help reduce that inflammation. Of course, prednisolone helps also. My cat is on it every other day (pills). In addition to his general sensitivity thanks to his past parasite history, he also has food sensitivities and environmental allergies (and asthma). He is suddenly unable to deal with commercial thickeners like carrageenan and guar gum in wet food without getting diarrhea.

Sometimes, for no apparent reason, he will have a "flare-up" of IBD conditions with no changes in diet or environment. When it lasts more than a few days, I get a fecal test to be sure he didn't pick up a parasite from eating a bug in the house (he's indoors 100%). If that's clean, we get 10 days of metronidazole/Flagyl and that usually calms things down.

I do feed all three of my cats S. Boulardi probiotic daily in Full Bucket Health Daily Cat supplement and it seems to work. Only one of the three takes a solid poo, but the other two have improved. My standards are...if I don't have to sipe their butt after they use the litter box, it's not technically "diarrhea"

 

[Sillycat41]

like way too
Have you talked with the vet about all the stuff you are giving him and about the blood work results? Besides all of the things to try to curb the diarrhea, what else is he currently taking?

Have you been doing anything to counteract the CKD? I am not familiar with anything you are giving him that would worsen his CKD, nor do I think diarrhea would cause it either. However, dehydration can cause elevated kidney numbers, especially BUN. So can stress.
Even some cats with a creatinine of 3.8, much less 4.2, get routine sub-Q fluids at home.

Is Jengo still eating well? Losing weight? Usually cats with his numbers tend to be a bit inappetent. His phosphorus is also high enough to be treated, either with renal foods or with a phosphorus binder. With IBD, some cats get B-12 injections to help with food absorption in the bowel. A cobalamin (B-12) blood test can be run to find if his is low - although it is possible the loose stools aren't helping matters any.

Is your regular vet back now? I think all of this needs to be discussed with them - at length, including the ultrasound. I would think he needs to come off some of the anti-diarrheal aids - it just sounds
much.

stephanietx - you have the dates backward, his kidney numbers have increased.

FeebysOwner: Thanks for responding. Sorry, I was in panic mode and didn't write enough details.

I had a long list of questions for the vet... he answered most of them. He said it was okay to give Jengo the probiotics even though he is on Metronidazole and Endosorb for the diarrhea. Didn't think the slippery elm or clay would help though. As for the blood work results... I didn't get them until the next day so didn't discuss them yet and now with the holiday weekend he probably won't get back to me until Tues. or later because the thyroid test results won't be back until later in the week.

Jengo's current meds:
⦁ 1/2 Zofran (Ondansetron) pill AM & PM
⦁ Porus One daily
⦁ 1/4 Mirtazipine every other day
⦁ Budesonide once a day - PM
⦁ Metronidazole once a day - mid-day (replaced Tylosin)
⦁ 50 - 70 ml sub-Q AM & PM
⦁ Proviable once a day & S. Boulardii once a day
⦁ B-12 injection once a week (tested a year ago)
⦁ Phos-Bind sprinkled on several meals a day

He has been on Porus One for years for the CKD... who knows whether is actually helps or not. I worry about the meds damaging his kidneys... like the anti-biotics and Mirtazipine. He does get dehydrated between the AM and PM sub-Q. He was probably slightly dehydrated at the vet, although I gave him about 40 ml an hour before we left for the 10 AM appt.

He still begs for food but only eats a little at each meal so I syringe feed him a couple of times a day with his meds in it.... about 8 meals in 24 hours. He has lost weight since having chronic diarrhea for 2+ months. I don't think he is getting enough nutrition since the food passes right thru him.

His regular vet is back from vacation and busy again. I asked about checking his blood pressure but he doesn't think it would be accurate in the clinic setting. I also asked about doing an ultra-sound but he wants to get the thyroid test back first.

I'm so frustrated because things keep getting put off and Jengo is getting more frail from the weight loss. I had seen another vet for a second opinion 6 or 8 months ago, but she miss diagnoses a heart problem so I don't trust her any more. No other vets in our area are taking on new patients and there are no specialists or emergency clinics.

I'm so stressed out and depressed... will probably lose Jengo soon due to lack of good veterinary care. My heart is breaking. :-(

Thank you so much for responding... I really appreciate it. Your comments and suggestions are welcome. Barb