Tumbles' Chronic GI & Urinary Issues (Timeline, long)

stephanietx

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My kitty, Tumbles is a 13 yo neutered male. (You can read his rescue story here: OMG! Just did a dramatic rescue...was almost a "bridge report" ) He currently eats Purina EN (wet) and Royal Canin Gastrointestinal (dry). He also gets twice daily s. boulardii and Adored Beast Gut Soothe.

In May of this year, he started getting picky with his food, not eating well, losing a little weight, and loose bowels. He has a history of loose bowels and gastroenteritis. Took him to the vet and there was nothing obviously wrong with him when he was examined. She gave us some prednisolone, metronidazole, and told us to continue with the antacid (Pepcid). He improved for awhile. We chalked it up to my return to work outside the home after about 6 months of being off work.

In late June, the symptoms returned, but with raging diarrhea. Called the vet and she gave us another round of metro, which helped. Took him in and they drew blood. Again, nothing out of whack on his bloodwork. Tried all the things for inappropriate elimination (new litter, new boxes, Cat Attract, Feliway plug ins, which we use regularly anyway), but the litter changes made things worse.

In July, he again had raging diarrhea, was not using the box to poop or pee, not eating, looked bloated, and generally wasn't comfortable. We took him to a different vet clinic that specializes in cats only. They ran the test for pancreatitis which came back very high. Sent us home with an antibiotic (Amoxicillin), metro, prednisolone, and Ondansetron. This worked wonderfully and he improved. He was peeing in the litterbox, but still not pooping in the box. We went back to the vet, she didn't find anything on examination, but recommended Prozac and continuing on the steroid. We did Prozac for 3 months. Still not pooping in the box, but his is pooping faithfully on a piece of packing paper on the floor, so we'll take it.

In Aug-October we tried weaning off of the pred, but each time we tried, the diarrhea and loose stools returned, so the vet said to keep him on it, which we did. Poop looked good, peeing faithfully in the box, still pooping on the paper.

Thanksgiving Day--raging, raging diarrhea, uncontrolled peeing everywhere, and lack of appetite. Started giving him metro, continued with the prednisolone, things improved, but not great. This past Saturday, he was seen by the vet again for all the things. She did a blood draw for the GI Panel to send to Texas A&M and she gave us a stool specimen tube to bring back for the diarrhea PCR test, also sent to Texas A&M vet school and lab. Hopefully, results will be in by Friday of this week or very early next week. (They only run the GI panels on Tues & Thurs)

Today, he is still peeing inappropriately. We picked up another round of antibiotics and she told us to up his prednisolone to 10 mg (currently on 5mg) for 3 days to get him over this hump. She didn't do a UA because this coincides with the flare up of the diarrhea and right now, the thought is that inflammation in the pancreas and GI area is causing everything to be out of whack. He's doing better this evening and has even used the litterbox to pee TWICE this evening!! (YAY!) He has finally eaten well, not normal, but better than all day, but he's starting to look bloated again.

If you've read this far, has anyone experienced anything like this? He's never been diagnosed with IBD, but treated like he has it. I just don't know what to think or how to prepare myself for what the tests might show.
 
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stephanietx

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Oh my goodness poor Tumbles, poor you!

So they're not thinking triaditus, even though he's not throwing up? Which is to say, this little sweetie seems to have a lot going on inside ☹

Symptoms and Treatment Options for Triaditis | ASPCA® Pet Health Insurance

Texas A&M will hopefully have a definitive answer.
They're not thinking Triaditis right now. I thought about it, but that 3rd piece isn't really there. It seems to be all inflammation based, at least from what I can tell. I can literally see his body expand. Depending on what the tests reveal, he may have an ultrasound. I'm also considering a change in food, but I don't really know where to go with that. I don't want to change too many things at one time and keeping things as is for awhile seems to be the least stressful thing for him right now.
 

silent meowlook

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Hi.I am sorry about Tumbles.
Have you had an abdominal ultrasound done with a board certified internal medicine specialist? If Tumbles was mine, that would be my next step.
Many vets including specialists would most likely recommend biopsies. And, that is probably a good idea. But, for me, I don’t like to have my cats have anesthesia and also don’t personally like the idea of surgery. But, that’s just how I feel. As, most would suggest that as a next step.
An abdominal ultrasound by a knowledgeable trained veterinarian can show signs consistent with IBD or Lymphoma, such as thickened mucosal lining of intestines and enlarged lymph nodes.
If findings are consistent with lymphoma, it may be time that the veterinarian will recommend Chlorambucil.
The fecal PCR and the GI panel are both good to do. If the cobalamine is low that is an easy fix with vitamin B12 injections.

You may want to talk to your vet about giving subcutaneous fluids at home when he has the diarrhea to avoid dehydration.

Pancreatitis is painful, so make sure they give you something to give for pain.
 

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Regarding the ultrasound, you can ask if it is feasible to set it up so that if the vet finds 'suspicious' tissue, they can do a fine needle aspiration (FNA) for analysis. This procedure does not require sedation any more than a standard ultrasound. Oftentimes, if a sedative is needed, it is to calm the cat before their belly is shaved more than it is needed for the actual ultrasound! Something like a small dose of butorphanol seems sufficient. It is short lived, fast acting, and in Feeby's (19+ yo) case it wore off very quickly. With her 2nd & 3rd ultrasounds with FNA, she did not evn need a sedative. The FNA can often take the place of a biopsy and is considered non-invasive.
 
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stephanietx

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S silent meowlook and FeebysOwner FeebysOwner the ultrasound will be the next step. The vet recommended these tests first to rule out "stuff" and then if the tests don't show anything or show us much, then we'll proceed to the ultrasound. They do the ultrasound in their office, which is convenient.

As for sub-q fluids, he doesn't need them at this time. He's not dehydrated, is eating okay and we add water to all the kitties' wet food, and is drinking. His poops have firmed up as well.

S silent meowlook the vet is hesitant to give him pain meds because it slows down the gut. If we have success with the pred, the Metro, the Cerenia, and the antacid, she wants to keep with that for now.

It's the waiting that's so hard and the fact I know he's not feeling well.
 
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stephanietx

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A little update:
The feline diarrhea PCR test came back negative for everything.
The GI panel shows very high TLI (Trypsin-Like Immunoreactivity) is super high at 235.7 with normal range of 12-82.

" Values of higher than 100 ug/L can be seen in cats with gastrointestinal disease, pancreatitis, and other conditions. A fPLI will allow for more specific assessment of your patient for pancreatitis. Also consider checking serum cobalamin and folate to assess small intestinal absorption."

Our current plan of action is: hydrolyzed food to decrease inflammation, increase his prednisolone dose for 14 days, then taper off, and weekly B12 injections for 4 weeks, then once a month.

Next steps: If this calms everything down, then we'll stay the course. We can also do an abdominal ultrasound to check for masses. After that would be a biopsy to test for lymphoma or other cancer.
 
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stephanietx

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Another update.

Started B12 last Friday. He was better until Sunday. He is now urinating outside the box, usually up on something off the ground. We have towels and pee pads down in his most common spots. I'm really getting tired of doing laundry everyday. His stool is still mushy, but at least now, it's only once a day and he's not running around crazy after he poops. He's back to pooping on the paper, which is better than not, but would really like him to poop IN the litter box.

We started him on the new food sent home by the vet, which could be causing some of the soft stool issue. That my just take some time to firm up.

We also scheduled an ultrasound for this Wednesday and asked for another round of Prozac, which has helped the elimination issue in the past.

I've never had a kitty with GI issues, so this is all new to me. It's frustrating, stressful, and discouraging.
 

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Do you have washable pee pads? You might be able to find some more on sale now, and also you can get towels at dollar stores, so that you don't have to do laundry so frequently (A baby, or adult incontinence, diaper "pail" that's larger could be helpful as well.)

Check into obtaining a roll of butcher block paper for the poops. Walmart's got a 100 ft roll for about $13.
 
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stephanietx

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Do you have washable pee pads? You might be able to find some more on sale now, and also you can get towels at dollar stores, so that you don't have to do laundry so frequently (A baby, or adult incontinence, diaper "pail" that's larger could be helpful as well.)

Check into obtaining a roll of butcher block paper for the poops. Walmart's got a 100 ft roll for about $13.
I have disposable pee pads for now. I have a bunch of "cat towels" that are retired people towels. We have a roll of packing paper and a roll of butcher paper we've been using. If he doesn't poop in the box, which he was doing for 4 days prior to Thanksgiving, he will poop on the paper. I do the laundry frequently because the urine smell is so strong I can't leave the soiled item in any kind of hamper or in the washer.

I am hoping to find answers on Wednesday with the scan. We also will start on Prozac every other day tonight. I just hate the it alters his cute personality so much.
 
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stephanietx

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Ultrasound update: It was the best news we could hope for!
Gall bladder, spleen, liver, kidneys all look great and healthy.
Lymph nodes look "boring" so vet doesn't think it's cancer, but can't rule it out without an endoscopy, which is very expensive

Bladder showed swirling debris. UA determined no infection, crystals, or stones.
Pancreas is unhappy, but he was diagnosed with pancreatitis in June/July so that was expected. His pancreas numbers do not indicate an active flare up right now.
Intestines have thickening, which we suspected, but it's not horrible compared to some other kitties she's seen, but it's making life miserable for Tumbles and us.

Course of action:
Continue on Ondansetron 2x/day
Continue with B12 shots weekly (can increase to 2x/wk)
Continue Cerenia daily
Continue with food transition
Continue current probiotics (s. boulardii & Culturelle)
Continue Prednisolone

We can also look into something like a Kitty Biome test to figure out what bacteria is present or absent in his gut and work on that.
We will also add pumpkin puree back into his wet food, which may be all we need to do to firm up poops.
We can also add Seimthecone (Gas X) to help reduce gas if Cerenia isn't cutting it.

If no improvement, the next step is an endoscopy where a biopsy will be performed to check for cancer.

Here's my boy with his shaved belleh during his ultrasound. He looks very pathetic.

Tumbles ultrasound.jpg
 
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stephanietx

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This is my online journal, especially for others in this situation.

We are currently feeding canned RX Royal Canin PR (rabbit) and also adding in plain canned pumpkin puree again. We had stopped doing this because our old girl had passed and our other 2 girls didn't seem to like it in their food. Apparently, it was really helping Tumbles! We had nice poops today and he's using the litter box to pee more frequently. (Hooray!)

The vet also recommended adding Simethicone (baby Gas-X) to his meds to help decrease build up of gas. He is also on Cerenia, but we can literally see his belly area expanding with gas after eating, especially his old crunchies. We're doing a slow transition to the new crunchies.

He also continues Prozac every other day for a bit longer until everything calms down.

The vet said his gut flora is completed gone, so we have been supplementing with probiotics, but I ordered a Kitty Biome test to see exactly which bacteria is lacking and to check for an overgrowth of any bad bacteria.

I also resumed Adored Beast Gut Soothe and ordered Healthy Gut to help the flora in his gut so hopefully he can come off of a lot of the meds he's on at some point in time in the future.
 
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stephanietx

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It's been about 2 weeks since his diagnosis and the food transition began. It's not going well. At first his stool was loosely formed, but it eroded to complete diarrhea, general discomfort, lots of gas, and bloating. He was very uncomfortable and would only lay on the couch next to one of us, not in his beloved heated bed.

On 12/27, I immediately stopped the z/d and put him back on a mix of wet foods he's had before that didn't cause him problems: Purina EN, Royal Canin Gastrointestinal, and Instinct Venison. I also added Slippery Elm Bark, first powder directly into food, but then created a boiled mixture of 1/2 cup filtered water to 1 teaspoon SEB powder, giving 1/4 teaspoon of the syrup twice a day in wet food.

Yesterday, 12/27/23 he had a much better stool, with no diarrhea! Yay! This morning, his poop was even better and he's had 2 good days with no discomfort or gas.
 
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stephanietx

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Two month update.

Tumbles has improved considerably! We have successfully transitioned him to Royal Canin gastrointestinal, which he's eaten previously, and supplementing with RAWZ duck and turkey varieties as well as Instinct venison. He is still eating RC Gastro dry.

We have reduced his meds (yay!) He's now on monthly B12 shots, prednisolone 5mg daily, Zofran (Ondansetron) as needed for nausea, and Simethicone 0.3ml one to 2 times a day. He is still on Prozac every other day and that seems to help his overall anxiety. Started him on Adored Beast's Gut Soothe and Visbiome Vet constipation care, which has really helped him, even though he's not constipated.

He is once again pooping nice poops IN the litter box!! (Woot!) He's very consistent, but if his tummy is out of sorts, then he will poop on the floor. This has only been happening maybe once a week for the past few weeks. He's sleeping better and some of his previous quirky habits have returned as well.

He has his 3 month check up in a couple of weeks and we hope to reduce his prednisolone dose to every other day.
 
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stephanietx

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Tumbles went to the vet for his 3-month check up and the vet is super pleased with his progress! (It's been A LOT of work!)
He's gained a little bit of weight, but nothing drastic, which tells her his IBD is under control and nothing is flaring up internally. His abdominal exam was the best it's ever been since all this started last summer. There was no pain or discomfort as she checked him out and she didn't feel any inflammation or gas bubbles. Since he's on a daily steroid, she did want to check his blood sugar. It was absolutely perfect, so he's not developing diabetes. She was also satisfied with the diet changes we've made and his current meds/supplements. She said we can try going down to every other day on the steroid and see how he does and also try Zofran and Simethicone as needed, or every other day. She did caution that he would have flare ups, but we are now equipped to handle them immediately, rather than needing to go to the vet to get diagnosed and treated.

His current med/supplement routine:
Prednisolone 5mg daily
Zofran (Ondansetron) 1/4 tablet twice daily
Prozac (1 every other day)
Simethicone (0.3-0.6 mL up to 3 times a day)
B12 injection monthly
Adored Beast Gut Soothe (working up to a full serving)
VisBiome Vet probiotic
Saccharomyces Boulardii

He's doing so well we don't have to go back to see her for 6 months, unless something comes up. The best part is that he is once again pooping in the litter box 99% of the time. If he doesn't, it's because his GI tract is not quite right and we up his meds.
 
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