Chronic loose stool caused by intestinal or pancreatic disease?

Vivian was given fortiflora twice a day for one week, as her vet instructed, and sadly but not unexpectedly it has had no effect on her loose and frequent stool. She is still eating and drinking okay, sleeping a lot - any diarrhea caused by hyperthyroidism should have cleared by now. In my most recent exchange with the vet she said her main concern at this point is a malabsorption issue. She recommends a blood test TLI, folate, B12 and an additional test for pancreatitis if I want to pay an additional  $70. All together this is a $300 blood test that would indicate pancreatic insufficiency, pancreatitis or disease of the intestine which may or may not be caused by bacterial overgrowth and treatable with antibiotic. If I understand correctly. Which it is highly possible I do not. It's complicated. I do have Vivian's lab results from before her thyroid surgery. There were several numbers out of normal range, but the vet said most if not all of them could be caused by hyperthyroidism: low BUN, low creatinine, low albumin are all symptoms of malnutrition. This can happen when raised metabolism causes food to race through digestive tract without time for absorption of nutrients. 

Of concern is also higher than normal monocyte, which can signal infection. It seems Vivian could have a disease or problem in her digestive system that happened at the same time as her hyperthyroidism and which has not been addressed by the thyroidectomy. 

Although the vet didn't mention it, Vivian's blood test from September also showed changes in liver values. I'm guessing we are looking at things most likely to cause loose stools and weight loss. Of course I will do whatever testing could help Vivian, except possibly surgical biopsies, but I feel like we are at the beginning of what could be a really long process of elimination. Any experience with this test (TLI, folate, B12) on a cat with loose stool and weight loss?

* This is part of a thread I started about my cat Vivian, entitled "Post Unilateral Thyroidectomy"

There are two tests for pancreatitis, one is a snap test the other one has to be sent out.  The one that is sent out is done at Texas A & M and is the best one for diagnosing pancreatitis.   Although IBD is a diagnosis of elimination the B12 absorption test is a very good indicator for IBD.  I am not familiar with the other tests but I think those two would be good to have done if you can swing it financially.

Is the diahrea really smell bad?

I am not familiar at all with pancreatitis, although some forum members are. I do know, though, that symptoms like loose stools/constipation and weight loss are rather vague and can indicate any number of diseases. In particular, intestinal diseases like IBD (which can commonly occur alongside pancreatitis) are difficult to troubleshoot. I had to take my cat to 3 different vets before the last one my complaints of appetite problems and constipation got diagnosed as IBD.

So while I would recommend getting the blood tests, please be prepared that you may not get an immediate answer and yes, there may be more tests necessary in the future.

As I understand it, TLi tests for exocrine pancreatic insufficiency EPI, where the pancreas doesn't produce enough digestive enzymes -

The test for pancreatitis can show if the pancreas is inflamed, which may prevent digestive enzymes from leaving the pancreas so they actually begin to digest the pancreas itself in extreme cases.

B12 test shows low or absent B12 because the intestine prevents absorption - indicator of bacterial overgrowth in intestine, intestine disease or EPI

Low folate is an indicator of disease of the small intestine; high folate indicates bacterial over growth in the small intestine.

From what I understand disease of the pancreas and intestine (and liver) often occur together - their jobs are all closely interrelated in the digestive process, and trouble in one area can cause or signal trouble in nearby areas. Will learn more next week I guess.

Meanwhile, I emailed the vet about giving Vivian some canned pumpkin to see if it addresses her loose stool, as I have read on this site of some some cats reacting favorably. She said she uses canned pumpkin on cats with constipation and megacolon, not loose stools. Oops - I already gave Vivian a little this a.m. before the vet returned my email.  

Cat Pal said:

 
Meanwhile, I emailed the vet about giving Vivian some canned pumpkin to see if it addresses her loose stool, as I have read on this site of some some cats reacting favorably. She said she uses canned pumpkin on cats with constipation and megacolon, not loose stools. Oops - I already gave Vivian a little this a.m. before the vet returned my email.  

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Pumpkin is used for EITHER constipation or loose stools. So while there is a lesson to be learned in that it is best to resist temptation and administer treatment after getting official medical opinions, there is also the lesson that the medical professional's opinion can be wrong. Pumpkin as a remedy should be fairly basic knowledge for your vet. If you're not getting a good feeling otherwise, you might want to look at other options.

http://www.petmd.com/blogs/thedailyvet/pmahaney/2012/nov/health_benefits_of_pumpkin_for_pets-29465

Hope the pumpkin helps!

Vivian had her appointment yesterday and blood was drawn for 2 pancreas tests - pancreatitis and pancreatic insufficiency - and two B vitamin tests which would indicate an absorption problem in her small intestine. Additionally I had them run a full standard blood panel to see if thyroid, kidney, liver, white blood cell values have normalized since thyroidectomy. Vet wasn't going to do this, and all this testing is $$, but I want to see if these things have all resolved.  The good news is she has gained a few ounces despite frequent and loose stool. The bad news is that she is having blood in most of her bowel movements now and the quantity seems to be increasing, still not large volume. Whatever is going on with her it seems to be causing colitis, unless there is another - egad - reason for lower intestinal bleeding. She feels good, she eats, she is maintaining her weight since her partial thyroidectomy, it's the pooping that is so disturbing. I brought in a sample for a giardia test, another special request from me since standard fecal parasite testing doesn't include the test for giardia, and Vivian's symptoms are consistent with this parasite. In any case, she was negative for giardia, but the vet commented on how very stinky her poops are! Huh, that's true, they always have been. I wonder...

Have you tested for Tritrich ?

http://www.cvm.ncsu.edu/docs/documents/ownersguide_tfoetus_revised_122009_final.pdf

I have not tested Vivian for Titrich, she has had a standard fecal parasite test and a giardia test, both negative. I see that a lot of folks on this site talk about this parasite a lot. Are they mostly people who run catteries or get their kittens from catteries or breeders? The disease seems to affect younger cats, those who come from places with large numbers of cats. She doesn't go to cat shows...I have had this cat for almost 10 years and she has only shown symptoms for three months. She has no contact with cats other than Willis, who I have had for 10 years and has no contact with other cats. Did you know on the link you sent me it described experiments where they purposely infect cats with this parasite ??? I question the ethics here, then again I also question the ethics of catteries and cat shows, as well as breeding cats for characteristics that may bring harm to them (such as pushed in faces, freakishly folded tiny ears. overly docile temperaments, etc.) so I am not in the mainstream here I'm sure. In any case, thanks for advice, if current tests don't lead anywhere, I intend to suggest a full fecal test for infection, uncommon parasites or anything else that could be causing Vivian's intestinal distress. Of note also is that Vivian is a bit of an anxious cat and there is also such a thing as stress colitis, so many possibilities... things looked slightly better (not great) in the litter box this a.m. but that's the way it goes, consistently inconsistent

So the tests are in: low B12, high folate, normal PLI and elevated TLI, but not really high. Without a biopsy the vet suspects IBD or a cancer.

Though she says getting intestinal biopsy (possibly laparoscopically) is the gold standard for confirming one or the other,  the treatment is essentially the same in both and the test is more for the person than the animal. Cats with cancer will have a shorter life than cats with well-managed IBD.

I have an appt. with the vet Wed. to make a plan for treatment. So far I have started B12 injections at home, which could lead to improvement almost immediately. Otherwise we can move up the ladder of diet change, metro, prednisolone...I would go, and have gone to great lengths to help Vivian get healthy, but I struggle with the notion of putting her through a biopsy if it won't really change the treatment. Her thyroid hormone, kidney and liver values have normalized since thyroid surgery, and she has even put on a few ounces. But she continues to have frequent loose stool with some blood and mucus - I guess the plan will be to continue trying things until that clears up. Thoughts?

Low B12 does mean poor absorption which would be indicative of either IBD or Lymphoma or something in between.  Often the analysis of the cells is subjective.  Often they are strongly showing just IBD sometimes strongly Lymphoma and sometimes they are in that gray area between the two.  With your other kitties issues I don't know about the issues that could come with a steroid.  My kitty takes Prednisolone to control IBD.  I would ask your vet about the possibility of using a steroid if only short term to get the inflammation under control.  The inflammation could be IBD now but turn into small cell lymphoma, it's kind of a continuum thing.  Using a steroid short term to get the inflammation under control then weaning him off of it while trying the non-medicinal ways of controlling inflammation might be a good idea.  I don't know about the effects on his other conditions though, your vet would be your best resource for info about medicines.

Speckled blood, mucous, loose stool like cowpies and really awful smelling.    That fits a description of tritrichamonas.   Doesnt mean it is.  But it should be on the radar.    One way to bolster this theory is that when given antibiotic  it slows the tritrich parasite down and the stool improves.   Then when you stop the antibiotic they become active again and the diahrea returns.   So you may want to try a course of antibiotics to note what happens.

It is also possible your cat picked it up in the hospital where she had the thyroid procedure.   

zoneout said:

 
Speckled blood, mucous, loose stool like cowpies and really awful smelling.    That fits a description of tritrichamonas.   Doesnt mean it is.  But it should be on the radar.    One way to bolster this theory is that when given antibiotic  it slows the tritrich parasite down and the stool improves.   Then when you stop the antibiotic they become active again and the diahrea returns.   So you may want to try a course of antibiotics to note what happens.

It is also possible your cat picked it up in the hospital where she had the thyroid procedure.   

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It's also indicative of colitis.  

My cat's thyroid surgery was done after I brought her to the vet BECAUSE of the loose stool and weight loss, and a thyroid tumor along with hyperthyroidism was found. I get it that this titrich parasite is causing trouble with the cat population, I will even mention it to Vivan's vet on Wed, but her symptoms and blood analysis - along with age, living arrangement and lack of exposure - point to problems other than this parasite. I am also not likely to put her on an antibiotic then take her off then put her back on (antibiotics themselves play havoc on digestive systems) just to test a theory. I would do the test for the parasite itself, just as I did for giardia and for other parasites.

If they used a microscope to look for giardia they would have seen the tritrich parasite. They look similar. But if another test was used for giardia then the tritrich would go unnoticed.

Here is a worthwhile page on diahrea. It says diahrea can be related to thyroid issues.

http://www.cathealth.com/digestive-system/cat-diarrhea

Hyperthyroidism wouldn't cause the low B12 which is indicative of malabsorption of nutrients in the small intestine.  Malabsorption is usually caused by some type of intestinal disease like  IBD or lymphoma, pancreatitis, giardia, or bacteria overgrowth.

I don't know how receptive your vet is to things outside of conventional medicines but there is a yeast probiotic called s. boulardii which has been subjected to conventional clinical trials.  It has shown itself to be effective in restoring normal gut flora and also restoring normal bacteria levels.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/   This is an article about it from a very conventional source for human medicine.  It has also been used in small animals like cats with success.  You might also bring this up to your vet.  Since it is finding it's way into conventional medicine your vet may know about it.

Thank you, I am going to ask about more long term use of a probiotic, Vivian's loose stool was unresponsive to the one week course of probiotic she was put on three weeks ago, the vet said it works that quickly for some cats and if not, it's just not the answer for others. She is, however, open to trying things that may or may not help Vivian, but will do no harm. Vivian's hyperthyroidism/tumor were detected as a result of her weight loss and loose stool. The surgery corrected the hyperthyroidism and associated abnormal kidney and liver values, and apparently has addressed the weight loss at least in part, because she has gained a small amount of weight. It seems the intestinal problem manifested at about the same time as the hyperthyroid, because all symptoms were originally thought to be associated with hyperthyroidism, but the continued loose stool after surgery led to more testing and a finding of low B12 and high folate, indicating malabsorption. If I decide against a biopsy, which I am inclined to do at this point but still very confused and undecided, I am thinking we will look for improvement with B12, and if not try diet change, and if that doesn't work move to medications. Of course my concern is that if it is cancer, these approaches will not slow it down. Prednisolone is a treatment for both IBD and the symptoms of some cancers, but does not slow down the cancer itself or prolong life, as do some chemotherapy drugs, if I understand correctly. Some people treat suspected but not diagnosed intestinal cancer with a combination of prednisilone and Leukeran just to cover more of the bases. Not sure where the vet falls on this subject. She does understand my desire to help Vivian to be as healthy as possible for as long as possible, with the least amount of stress. Her quality of life will suffer if I start having to shuffle her around between home and hospital for this or that procedure. She is intensely anxious about car travel and vet visits - some tough decisions ahead I'm afraid. Anyone have experience treating for IBD or IBD/cancer without the actual biopsy?

I didn't have a biopsy done.  Patches had the ultrasound and complete blood work done but no biopsy.

Cat Pal said:

 
 Anyone have experience treating for IBD or IBD/cancer without the actual biopsy?

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See  http://www.thecatsite.com/t/287719/...g-and-treating-ibd-and-or-small-cell-lymphoma