At wit's end

No wonder you are exhausted, you are putting everything in to trying to figure out what is happening for Sassy, and how to help her.  I keep hoping she will improve and there will be an aswer for her behaviour and for the diarrhoea.  Fingers crossed for the food, restarting the probiotic, and Prednisone along side the Pancur.  Don't know what effect if any the Pancur might have for her diarrhoea...      

with all that diareah there's a good chance she's getting dehydrated....lip licking is a sign its SERIOUS

So far today, all urine/marking has been box-contained.  No diarrhea, but that's because there has been no stool from her that I could tell.

I think I've seen her drinking; hard to tell if its enough, or how to encourage her to drink more.

If she is still urinating high volumes I would not imagine she is dehydrated suddenly at this point, but if you are worried you can always try adding water to her food as long as it doesn't put her off it.  Running and dripping taps can be useful too if you don't have a water fountain.

Good to have at least one day without soiling on the floor, and action in the box.

 I hope all is ok with your cat.  She had kinda the same issue with the cat urinating outside the box, and around the house. After watching a cat behaviorist tv show, she got an idea that worked for her cat.

 Apparently a stray cat was marking the yard of the house at his territory. My friend got a nice harness for her cat, and took her out to the yard for a safe, supervised stroll. She allowed the cat to survey the area, mark here and there. Seems the stray got the message the yard had an owner. After a while my friend's cat started to get back to normal.

 Seems the smell of the stray marking outside the house, made the indoor cat felt unsafe inside the house. The reaction of the indoor cat was to mark as much as possible to protect her safety zone. Once she started to mark outside the house it made her safe zone bigger, and the problem urinating outside the litter box solved.

if you have to get an eyedropper and get water into her

I'm late coming to this thread and I have to admit I just skimmed a lot of it, so if I'm repeating things you've already tried please let me know.

You said Sassy tested negative for parasites, but did the vet test for tritrichomonas foetus? That is not typically included in parasite tests. It requires a very specific medication as well, not the same as for other parasites.

Have you tried giving the amitriptyline in a single dose in the evening instead of twice a day? There could be several advantages to this. One is that you eliminate the stress of pilling her an extra time every day. You might also see a change in behavior in that the medication can make her sleepy initially and you might see her perk up as the day progresses. You might ask your vet about a topical preparation (it does come in that form). Since she hates the pills so much the topical application could reduce her stress. Also, be aware of side effects. Most of the information I've read on amitriptyline in cats lists constipation as a possible side effect, but in humans both constipation and diarrhea are listed. Who knows, the same could be true in cats.

On the subject of cleaning, have you used any brand of enzymatic cleaner besides Nature's Miracle? I've read a number of reviews that say you have to use a large volume of the product over an extended period of time for it to work. My own experience with it is that their products are basically ineffective.

I know you're transitioning her to a new dry food, and I really hope this works for her. Have you considered adding some wet food to her diet? There are a number of articles on nutrition that have helpful information.

GoldyCat said:

You said Sassy tested negative for parasites, but did the vet test for tritrichomonas foetus? That is not typically included in parasite tests. It requires a very specific medication as well, not the same as for other parasites.

Have you tried giving the amitriptyline in a single dose in the evening instead of twice a day? There could be several advantages to this. One is that you eliminate the stress of pilling her an extra time every day. You might also see a change in behavior in that the medication can make her sleepy initially and you might see her perk up as the day progresses. You might ask your vet about a topical preparation (it does come in that form). Since she hates the pills so much the topical application could reduce her stress. Also, be aware of side effects. Most of the information I've read on amitriptyline in cats lists constipation as a possible side effect, but in humans both constipation and diarrhea are listed. Who knows, the same could be true in cats.

On the subject of cleaning, have you used any brand of enzymatic cleaner besides Nature's Miracle? I've read a number of reviews that say you have to use a large volume of the product over an extended period of time for it to work. My own experience with it is that their products are basically ineffective.

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1)  I don't know specifically what the vet tested for.  Receipt indicates (2) tests - Fecal Stain and

2) We split the Amitrip into 2 smaller doses because she is so small.  We were genuinely worried that even 1/2 tablet would be too much all at once.  We have been wondering about reducing it to 1/4 tablet 1x/day.

3) We had started using an enzyme cleaner from Walmart, I think its simply called "Out."  We used it primarily when our other cat would vomit and then when Sassy started going outside the box.  Switched to Nature's Miracle after doing some research.  Not convinced either one is completely effective.

Latest update:
All seemed to otherwise be going well.

Last night, there was another puddle of diarrhea in the open-air tub.

This morning, there was urine/marking from her in the open-air tub, a clump from Striker in the covered box...and urine on the floor near the covered box, first time in maybe 24+ hours?

Today, we will be increasing the mix of Blue/Z-D to 50/50.

Yes, I would agree with the suggestion made by Goldy Cat to try a bit of wet food as this will introduce some additional moisture by virtue of wet foods containing more water. It would also allow you to add a little water to the wet as a little insurance to prevent dehydration. If given as a treat, it might serve to please, and it turn, lift her spirits.

Sounds like Sassy is enjoying the new diet. This is good. If you see a slow-down of stool for a day or two, don't be too alarmed as whenever you change diets, this can have the effect of changing the output (hopefully for the better) as her system is getting adjusted to the new food.

Hard to believe that I have been carrying this on for 3-4 weeks.

Possible sign of hope? A little while ago, I noticed Sassy "trying to find her butt."  This is typically a sign that she has just had a movement, and is wanting to clean herself.

When I checked, I found diarrhea in the open-air tub.  However, the diarrhea ALSO looked like it had what may have been the beginnings of formed stool.  Can't believe, also, this is something I have become an "expert" in, but...

Although there was one incidence of urine on the floor over 24 hours the general trend seems to be a lot more positive than where they started out, and hopefully you will continue to make progress.  It feels frustrating though as still no real understanding of what is happening for Sassy.

Given @GoldyCat's comments about Natures Miracle - I don't know if it is helpful or otherwise but when I used to clean up snowleapard and Pal's mess I used what I'd read in a newspaper somewhere - it was a long time ago and I don't think there were that many enzyme cleaners around for animal soiling.  I also used the same technique on a grand scale when a person or fox urinated in the communal area of our building which has painted walls and concrete floor (not painted and is porous sadly) so the area stank like a men's public latrine.  It worked so:  make up a bucket of water with a fairly concentrated dose of biological laundry solution.  Doesn't matter whether it's powder or liquid biological laundry product you use as long as it is dilute but concentrated.  Wash over the affected flooring and wall surface using ample solution, scrubbing in if necessary, and rinse off.  Repeat a number of times once you dry it off if you feel there is any residual odour.  I did our floor about 5 times in quick succession as soon as it dried out so maybe over an afternoon or morning.  Finally wipe over the area with a  sponge or cloth wet through with surgical spirit. Allow to dry off naturally.  I read that the combination of the enzymes and the alcohol removed both the proteins and other substances in the urine that create the lingering odours.

billchamb said:

2) We split the Amitrip into 2 smaller doses because she is so small.  We were genuinely worried that even 1/2 tablet would be too much all at once.  We have been wondering about reducing it to 1/4 tablet 1x/day.

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What is the strength of the tablet that you're splitting? Please don't change the medication without checking with your vet first. You need to be especially careful with amitriptyline because it's one that has to be tapered off, not stopped suddenly.

Just an observation but with that much diarrhea there is a good chance she's dehydrating herself. Cats have a low thirst-drive as compared to other animals due to being obligate carnivores. This means they get most of their water from their food as that's how nature designed them. You may want to start watering down their dry food or introducing wet canned food to them.

GoldyCat said:

What is the strength of the tablet that you're splitting? Please don't change the medication without checking with your vet first. You need to be especially careful with amitriptyline because it's one that has to be tapered off, not stopped suddenly.

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Whole tablet = 10 mg, but prescribed dose is 1/2 pill (5mg) 1x/daily.

No, I would not change medication doses without consulting vet.  It was vet's recommendation to also try giving 1/4 tablet 2x/daily.

Sassy is small, between 5-6 pounds.

Wow, a little girl for sure .. Is that her in your Avatar pic? Very cute.

If you haven't tried this already, I wonder if Sassy would be interested in pill pockets to hide the Amytrip in? Here is a link to one product : http://www.greenies.com/cats/pill-pockets.aspx. Might be more pleasant for her.

I would be more concerned with giving too much of the Amytrip, rather than a lowered dose.

I am brand new to this board....I have read your posts and sure understand your dilemma....

1.)     I would very much suggest a Cat Specialist.  I drive 90 minutes each way to a cat specialist  and this guy really knows his stuff.  His take is way different than the regular dog/cat vets who many times treat cats as 'little dogs."    Go to  www.catvets.com   which is the Association of Feline Practitioners....they have many cat specialists listed there by region.  You have come this far, but I am not seeing that you are going to a cat specialist.  I had similiar problems and went round and round until I got to the Cat Specialist, who really helped me with all this, because he REALLY 'gets' cats and all the details much better than regular vets.  

2.)    Secondly, someone mentioned the Feliway Diffusers.....they are EXCELLENT.   Not cheap, but I get mine for about 40% less at    www.drsfosterandsmith.com  ( drs. foster and smith )  with the plug in diffusers....this stuff works like a MIRACLE to calm cats down.  I have one in their bathroom area and a couple others thru my small house.    It REALLY helps to calm them down.  And is NOTED to stop emotional peeing and marking. 

3.)     The environment, someone else mentioned,.....that can play a part.  Any new cats or animals or people in the house prior to all this starting or during it?  Any room redecorating, new furniture, new rugs, new ANYTHING?   All this can upset their fragile emotinoal balance.   Any stray cats outside coming to the window?  ( they can start marking their territory at that point )    I had this start at one point with my neutered, 8 year old tuxedo, I redecorated a room and then brought in another kitten, who was fine until he got to be about a year old and started trying to dominate her.   He stole the top seat of her cat tree and generally harassed her...we got to the cat specialist, ruled out medical stuff , did the Feliway Spray, bought a second cat tree.  

4.)  Anal Glands:  My female tux also is one of those cats that has to have her anal glands checked and drained about every four months...if not, she starts peeing around.   

5.)  Food:    What type of food are you using?  If there is even a slight idiopathic cystitis, bladder inflammation that is not due to infection ( kind of comes and goes with stress )  check with your vet about usuing Science Diet CD  or Royal Canin SO for bladd conditions.  Even if nothing is showing up, they can have this inflammation at times and the right food on a continuous basis can make a difference.

6.)  In addition, are you aware that Natures Miracle has a special forumla just for CATS?    When I have had the issue, I spray and saturate the carpet with that and within TWO HOURS the smell is GONE.  That is not helping the problem necessarily but will definitely help the smell.  I rent, so I sure know your concerns about all this. 

Please forgive me if I am repeating stuff that has already been said, I tried to read everything so as not to be repetitive.  I hope this helps.  I sure know what you are going thru.

So, your post made me realize just how awful that old avatar was.  I changed it to Striker's "mug" shot...

Ahh, they are both beautiful .. I have Tabbies as well and Sassy looks a fair bit like my Maggie, except for the eyes of which hers are green. Striker looks very intent/determined in that photo. Good choice for avatar pic.

My comment about the Amytrip was in response to your splitting the tab and how this would be less of a concern for me than if you were giving too much, which you aren't.

If the pill pockets are not a go, maybe hiding the pill in some tasty wet food might work?

Ive read over the last few pages but did not see anything as to why the vet chose the pills over feliway. If Stryker us doing something to cause the stress then thus will help him too. I also want to commend you on the extraordinary love and patience you have shown poor sassy.