Loose Stools - Weight Loss - Stumped Vet

My 16 y/o, indoor only cat has something wrong with her and the vet cannot figure it out. I was hoping maybe someone here might have some ideas.

Basically, the cat has loose stools with occasional vomiting. I think it's worth noting that up until maybe several months ago, she had hard stools/constipation. She used to eat primarily dry food (her choice), but has been eating much more canned food in the last several weeks or so (not sure why as this is very unusual for her). She has been losing weight and is very thin, but is well hydrated. Her coat looks good. She may have some sort of abdominal discomfort and seems to be happier (more relaxed) with a mildly heated blanket.

In the past two weeks, she has really gone downhill. She had complete blood work with a urinalysis and everything came back in the normal ranges. Her T4 was in the middle of normal, but she does have many signs of hyperthyroidism. Her pancreas tested normal (they call it fPL). All her vital signs were ok, except her blood pressure might be high. I forget the exact number but it's close to 160. The preliminary results of her ultrasound didn't show anything significant. The vet thinks (based on what I've said) that she has small bowel issues, but isn't sure what's going on. It's also worth mentioning that something may be going on with her heart and her vision seems to have recently become impaired. Her cognitive function also seems to be deteriorating. All of this came on somewhat suddenly about two weeks ago.

So far, many things have been mentioned, but we are waiting on the final results of the ultrasound. Unfortunately, I'm not sure it's going to tell us much, if anything. The vet has mentioned trying things like B12, Metronidazole, one of those prescription IBD types of food, and exploratory surgery. I know she received a B12 shot last week, but I haven't seen any noteworthy changes.

Her diarrhea usually has no smell (or maybe my nose doesn't work), but there were a couple of smelly ones. I do know the vet said she felt gassy last week on examination. The one night, her vomit (liquid), smelled vaguely of feces at first, but I don't believe it was.

Any ideas? Or any suggestions what we should try? Something needs to be done soon, she's so thin.

What brand of food does she eat?

Her symptoms sound similar to what my oldest (now 16) had 3 yrs ago. The difference is that Lucky had very fowl smelling diarrhea and the diarrhea and vomiting both contained blood (though initially did not.) We did full bloodwork, x-rays and a barium test and all came back inconclusive. I opted for exploratory surgery in which biopsies were taken...results just showed inflammation. Lucky was put on I/d which didn't help any...actually made things worse (see below.)

Longer story short...
Through trial and error (and a lot of meds) I determined that Lucky (grew up eating Cat Chow and Purina Naturals) had developed grain/gluten/soy/carrageenan intolerance and also was allergic to pork. (Note...the I/d the vet put him on contained all of his "triggers"...this why the food made symptoms worse.)

Lucky now eats limited ingredient diets and is doing very well! (Mostly Nature's Variety/Pride dry and canned NV, BFF and Tiki Cat.)

I'm not sure if this will be the case for your kitty or not, but certainly worth looking into.

Lucky's symptoms developed fairly suddenly and he lost 4 lbs in about a 6 wk period.

Your story is very familiar to me and I want to second what CatPack said.

You can search under my user name for some of the threads I started if you want to read more about Tim, but (and I will try to keep this short) Tim had a couple of very severe constipation/obstipation episodes so we transitioned him from 90-95% dry to 90-95% canned. He'd always had minor digestive problems like diarrhea, vomiting, and frequent hairballs, but they all became worse on the canned food and he also developed asthma. Multiple vets - two at our regular place and one at the emergency pet hospital - didn't really know what to do, as all diagnostic tests showed a healthy but stressed cat.

I decided to look at his food and noticed there were three ingredients that were always present when Tim had an immediate vomit episode (within a very short window of eating): carrageenan, xantham gum, and chicken. I decided to eliminate those three foods from his diet. Upon doing that, pretty much all of his symptoms resolved. I may try chicken with him again some day, but he's doing very well on a rotation of rabbit and turkey, with a small amount of pork, and I don't want to mess with anything. His stomach is still very sensitive, which we learned over the last week, so I really have to manage his diet.

What I've learned regarding Tim: 1) Gums and fillers do not agree with him. I am not sure about guar gum and I also avoid that, but may try that some day. I am also not sure about agar-agar, but he does eat a small amount of food with that every day and seems to tolerate it. But I absolutely avoid carrageenan and xantham gum. 2) Tim cannot tolerate high-fat canned foods. Because of all of Tim's limitations, I've had a terrible time with canned foods. Initially, Tim did very well on Nature's Variety Instinct LID turkey when I moved him from his original canned to that, but the formula changed and it appears much higher fat (it is much more "juicy" than it used to be, and that juice is fat). I still like this food because it's limited ingredient, but I have to drain off the juice and also make sure I don't feed too much. To give Tim variety and help his digestive system, I've transitioned him to about 70% raw.

Let us know what foods you feed. I would start there, if I were you.

Update:

I'm still waiting on the ultrasound results. One of the specialists had an emergency and hasn't been able to report back to my primary vet.

The impression I got though is that the primary vet and radiologist didn't find anything significant relating to the diarrhea. They may have found a heart issue.

I'm worried because my cat is losing weight and not eating much. But she still plays with her toys several times a day. She doesn't do any of her other normal activities (bird watching or asking for love), but she is obsessed with the toys. I think she burns more energy than she consumes, and that bothers me. I suppose it may be a good sign, but I don't know.

I'm starting to think she has hyperthyroidism (it produces all the symptoms she has). Her test was in the normal range, but when I requested a copy of the lab work, I saw that her T4 was actually borderline for the "grey zone" for senior cats.

I'm hesitant to change her food too much because last time she vomited, she nearly passed out/fainted and that worries me (part of the reason for the cardiac ultrasound). I don't want her vomiting again. I know there are several fish flavored canned foods she will eat, but I'm worried they might make her vomit. They shouldn't but I can't be certain. But maybe it's worth the risk just to get some food in her.

I didn't see mention of a fecal exam. Bacterial overgrowth? I know that it can be a bugger to get under control if not addressed, and can be caused by a number of things in sensitive / aging kitties. At 16 years old, new things could creep up. IBD? Malabsorption?    I know EPI can cause chronic diarrhea, but it is usually accompanied by an abnormal fPL. EPI is diagnosed with the TLI blood test.

Obviously I'm not a vet but I've had cats with similar symptoms. Some of the vets just called it old age, but obviously that's a short cut for the real problem. I've had cats with IBD (just because she's not responding to the diet doesn't mean she might not have it, there are other treatments than diet for example many supplements are available  - of course it might be completely something else to). Most of my older cats with these symptoms did have IBD, or allergies to the food, or in two unfortunate cases it was cancer. '

I dont' want to worry you but I think you should hope for the best but prepare yourself as well. I don't know how her health is otherwise but 16 is quite a good age for a cat. Not saying that you should worry until your vet says to, but just being realistic. Maybe it would be better at this point to keep her comfortable, and I say that with all due respect to you and your cat. Some owners feel they want to do everything they can to cure their companion, others feel they'd rather not do much invasive at an advanced age etc.

It's a very personal issue, and it's entirely up to you. But I would try to look at it (as much as you can of course ) from her perspective. Does she want to keep fighting? It really also depends on the cat... If  she does want to keep fighting - I would by all means continue. I'm not a vet so I won't say this is the end, but I just personally hate to see a cat suffer when really in all actuality it probably can't be cured. It seems inhumane to me, and I'm sorry if that offends you it's not my intention. Saying it more in general that's all... Maybe you will get another few good years with her, and I'm praying tonight this is the case, but being practical I would prepare myself a little for the worst  but pray for the best.

You're doing the right thing by taking her to the vet, and I'm sure she is well loved - hoping she gets better soon. 

The results of the ultrasound were pretty much inconclusive. They said there was something going on with the small intestine, but they couldn't tell what it was. They said it could be the beginnings of cancer but they can't tell at this point. They said we could try an antibiotic (Metronidazole) and/or prescription food (they're pushing Purina EN) and a probiotic (Fortiflora).

The thing that sticks in my mind is this: this cat has a history of dry, hard stools/constipation. So how does she goes from constipation to diarrhea? It seems like that should be focused on. Maybe that's the key right there. I'm not seeing anything that indicates old age or even cancer as the problem. I'm not saying those aren't possibilities, but her behavior (to me) is indicating that something else is going on. While I realize this could be the end for her, I don't want to give up on her because she still has spunk. She still zooms around the room several times a day playing with her favorite toy.

It's not like this diarrhea is completely new. She had a few bouts of it last year that lasted for only a day or two. I thought it was the food I gave her since one of the other cats had diarrhea too. Maybe she has some sort of intestinal parasite like Giardia. Maybe all the cats have it.

Another thing I wonder about is her food. After she lost/had all her teeth removed, she started swallowing her dry food whole. That was mentioned as a possible cause of the constipation - something that wasn't helped by canned pumpkin. I can't remember the timeline for her food changes, but several months ago I got her to start eating more canned food. The canned food could be linked to the diarrhea as I know the other cats have issues with too much canned food. The bouts of diarrhea last year are linked to canned food as well.

I feed the cats Purina One dry food and Friskies canned food. Once or twice a month I might give them some 9 Lives tuna in sauce as a special treat. I know those aren't the best foods, but it's what I can afford (all these cats were strays or came from a stray). Plus, the cats have done very well on this food in terms of heart and kidney problems. I would be interested in trying a homecooked or raw diet, but I am so confused about the nutritional part of the recipes (how much to feed, if the vitamins and minerals are included or need to be added, and if it's nutrionally balanced).

Cats with IBD can fluctuate between constipation and diarrhea. If the vet saw "something" going on, it could be thickening and/or inflammation of intestinal walls, which is oftentimes present with IBD and/or intestinal lymphoma (cancer). Food sensitivities can develop over time and as they age, and commercial foods can also change. Something she once tolerated could eventually turn out to be a problem for her. The only way to find out if the food is bothering her is to try something else, ideally something bland that is as natural as possible with few fillers and additives. If you want help with a raw or homecooked diet, check out the resource links at the top of the Raw & Home-Cooked Cat Food forum and start a new thread if you need help. I have a cat with chronic pancreatitis who seems to be sensitive to...well...everything. So I've been experimenting with a 100% homecooked diet.

If you're concerned about a parasite, then have a fecal done.

When vets don't know what's going on, sometimes they'll want to treat diagnostically. For example, if there's improvement with a trial run of a steroid like prednisolone, then perhaps there was inflammation. If there is improvement with metronidazole, then perhaps there is bacterial overgrowth/imbalance. If a food change fixes the problem, then maybe Purina and Friskies are at fault. Which reminds me...you should probably read this: http://truthaboutpetfood.com/report-it-please/. Sometimes they'll throw everything at you all at once and sometimes they want to change one thing at a time to see what's working and what isn't. It's really up to you and depends on your particular situation and severity of your cat's condition.

I'm not a vet, but I'm inclined to say that if she's still spunky and playing with her toys (a sign of happiness), then it's worth trying to get this resolved. If it were my cat, at 16 years old, I'd probably opt for more aggressive treatment and supportive care with the goal of seeing results quickly and giving her a good quality of life for the remainder of her time. If the cat were young, I'd probably be a little more patient with the wait-and-see approach of experimental treatments.

The vet did see and feel thickening of the intestine. I'm inclined to think it is IBD based on what I've seen here at home over the last few weeks, months, and years. But I do realize it could be cancer.

I saw the vet again last night and we decided to try Metronidazole (50 mg twice daily), an appetite stimulant and Fortiflora. I haven't used the Fortiflora yet. I wanted to make sure there were no adverse reactions from the other medications first.

I guess if these medications don't work, we'll try changing the food. We haven't discussed it yet. I'd really like to avoid a prescription food due to price and concerns with ingredients. Does anyone here have recommendations? I'd like to plan ahead.

Another thing - as far as I know, this cat has not had a bowel movement in 5 days which is extremely unusual. I mentioned this to the vet and she said the cat did not feel constipated, but said nothing else. I'm not sure if I should be concerned or not. I'm going to try to rig up a private litter box just for this cat so I can keep track of her bowel movements.


Oh! Thanks for that link about the Purina pet food. I've actually been wondering if there were any problems or recalls with Purina products recently. Some of my other cats appear to be losing weight, but I'm not sure if that's because of the food or because another family member forgets to feed them their second morning feeding. I'll have a better idea this coming week as to what's going on.
But, a relative's older cat (14 y/o) has lost a lot of weight recently too. I didn't even notice until he got a trim (he's long haired and very fluffy). Now it's clear he's lost at least a pound or three. I'll be keeping an eye on things.

I'm really upset and could use advice.

The vet told me to stop the Metronidazole after 3 days because I said my cat was acting uncoordinated and not playing (something that is unusual). I did that but am still using the appetite stimulant (this is also an antihistamine) and the Fortiflora. But I haven't seen much change. Some days are better than others. I can't tell if she's losing, gaining, or maintaining weight.

So I got a call today (the 23rd) that instead of me bringing in the cat for a weight check, the vet wants me to go to an internal medicine specialist, but the reason given was odd. The vet had talked about trying corticosteroids but I was hesitant and recently agreed to try them. But now the vet doesn't want to try them and claims they may worsen an underlying condition, if present. This is odd because we had just talked about trying them. There is no underlying condition that I know of unless the vet has withheld something from me from the ultrasound.

I won't be able to make an appointment with the specialist until the 29th because I am waiting for the vet to contact them with what's going on. The specialist wants more information than the cat may have IBD or cancer and the ultrasound was inconclusive.

The ultrasound only showed something is going on in the small intestine, but they don't know what it is. They said there was a problem with the heart, but it doesn't require medication at this time. All the blood work is normal. The cat has been showing neurological issues since having an epsisode of snycope (fainting) after vomiting a few weeks ago. The vet isn't sure if this ties in with the loose stools or not.

Does any of this make sense to any of you? I don't know what to do. One thing is for sure: I'm burnt out and no one understands it. Caring for a sick, clingy cat that isn't eating enough food is rough and worrisome.

It does make sense as far as medication, the metro, goes.  A few kitties do have neurological side effects from metro and they should quit taking it.  The appetite stimulant could also have what appears to be the same side effects.  There are two appetite stimulants commonly used and usually if a kitty doesn't tolerate one than the other one works fine.

I don't understand about the steroid.  I assume kidney values were checked on blood work so the steroid probably wouldn't make an underlying condition worse.  One thing about starting a steroid though.  A kitty on steroids won't have reliable results from a biopsy so maybe your vet wants to leave that option open for the specialist.

The kidney values are within normal. The BUN was on the higher side of normal. I know there was blood in the urine on the urinalysis, but they said that happens sometimes and they weren't concerned with that unless she was showing symptoms. Now she's urinating more frequently which indicates she could have an infection. It's my understanding that steroids shouldn't be given if there's an infection, but that wasn't mentioned to me by the vet.

I just did a little more research and came upon something to check into. This could be FIP. She has many symptoms of the dry/non-effusive type. She's having balance issues, occasional twitching, eye issues including discharge (thought she had vision problems for awhile), she's walking oddly and seems to have an issue with one of her hindlegs. All this on top of the loose stools, weight loss, and loss of appetite.

FIP in a senior kitty is very very rare.  I think it is more likely that their are multiple issues going on just as what happens to us humans as we age.

kh2b1 said:

The kidney values are within normal. The BUN was on the higher side of normal. I know there was blood in the urine on the urinalysis, but they said that happens sometimes and they weren't concerned with that unless she was showing symptoms. Now she's urinating more frequently which indicates she could have an infection. It's my understanding that steroids shouldn't be given if there's an infection, but that wasn't mentioned to me by the vet.

I just did a little more research and came upon something to check into. This could be FIP. She has many symptoms of the dry/non-effusive type. She's having balance issues, occasional twitching, eye issues including discharge (thought she had vision problems for awhile), she's walking oddly and seems to have an issue with one of her hindlegs. All this on top of the loose stools, weight loss, and loss of appetite.

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I agree with @Denice  above, FIP is very rare in a cat this age and very rare in general, and unless she's had exposure to other cats then you can rule that out.

As she also said, IBD and other inflammatory issues are often diagnosed presumptively through treatment.  It is very common to start a cat on Prednisilone if IBD is suspected, because if that's what it is, you will usually see weight gain inside of 1 week, it works that quickly.  It's also true that you can't biopsy a cat's intestines while its on a steroid, so one question is, given that she is 16, do you want to go through major surgery to determine what's going on? If yes then be prepared to do the surgery now.   My cat had this done and it is a big surgery.  But, the initial treatment for IBD and small cell lymphoma is the same, Prednisilone, so a diagnosis of the one vs. the other is not technically needed at least not at the start.  And small cell lymphoma is often the result of long term IBD morphing into SCL, not just a spontaneous case of SMC although that is possible.  

Diabetes or a heart condition would make the Pred riskier, although your vet said the heart issue was mild.  Sometimes you just have to treat the most serious illness and hope that the less serious one doesn't over take the first illness.  My cat has mild heart disease and serious IBD and he has been on pred for over a year with very positive results.

Even without a biopsy, of the cat responds to Pred for a while and then stops, you can still move on to drug #2, Leukeran without a definitive diagnosis of SCL, although not all cats can tolerate Leukeran.  

Please keep us updated!

In one of your previous posts, you said that your cat had not had a bowel movement in 5 days. I was hoping this meant things were starting to firm up. I suppose this was not the case? 

Metronidazole can cause neurological side effects, but I have read that is usually from very high doses and long-term use (months/years).   Of course, there can be exceptions. I have a cat that always seems to deviate from the "norm".  If the appetite stimulant is cyproheptadine, a common side effect is drowsiness / sedation. (Sources: http://www.veterinarypartner.com/Content.plx?A=1990 and http://www.petplace.com/drug-library/cyproheptadine-periactin/page1.aspx). Perhaps this is the cause of the decreased activity level you are observing? If nothing has changed after stopping metronidazole, then maybe cyproheptadine is the problem. 

Just from reading your post and the details you provided, it seems to me that your regular vet just isn't sure what direction to take and needs some help (without admitting it). Some vets really get throw for a loop when they don't have any definitive data to work up a treatment plan. An internal medicine specialist probably sees this kind of thing all the time and may feel more confident with their recommendations for your kitty. Again, I don't know. It's just the first thing that came to my mind.

My vet will sometimes change her mind after she's had a chance to do some research and read up on some more recent studies on VIN. The primary treatment plan 10, 5, even 2 years ago may not be the the same today. Perhaps your vet read something that changed his/her mind.

Also, on the blood work, how was the cat's potassium level? If it was in the normal range, was it low-normal?

kh2b1 said:

One thing is for sure: I'm burnt out and no one understands it.

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I understand it! 

As I read the long string of replies, I found most of what I wanted to contribute has already been said.  But I didn't see anyone asking you if you'd done just a simple thyroid test, or the complex, multi-part one.  The simple T4 test doesn't rule out hyperthyroid with a high-normal senior result.

My own 14-year-old responded well to metronidazole after a weight drop and vague symptoms, so it's a shame your sweetie can't handle it.  I'm quite unexcited about prescription foods, because they have the nutritional content of Cheetos.  My guy's Royal Canin kidney kibble has corn, wheat and soy in it, which is scarcely good for possible food sensitivities.  We've also had some serious problems with long-term prednisolone (15 months) for maybe-possible IBD, but his biggest side effects seem to be resolving as I wean him off steroids.  Still, a short term treatment might be helpful, or your kitty may respond completely differently.  I can only guess why the vet might have decided against it.

My vet sent me to an internist, too- which added some noise, and another huge bill, but no additional info. He did suggest a surgical biopsy, and my vet added the notion of exploratory surgery, but that sounded way too random to me, with too much stress for an ailing older cat, so I said no.  Just my choice.

Just a very random thought- I've gotten a very sick (kidney failure) kitty to start eating again by feeding Newman's Own canned food, chicken or turkey, which I think of as a gentle food.

Re fecals and parasites- be aware that the microscope only picks up some of what's there, and some infestations can be completely hidden.  But that's not really consistent with lack of appetite.

And, lastly, I'd like to second whoever mentioned other appetite-stimulants.  Maybe the cypro isn't working and something else might.

I wish I could reach through cyber space and give you both a big hug!  Hang in there.  I know how hard it is, when your kitty's sick and nothing you're doing seems to make any difference!  I've been going through exactly that the past couple of months.

Update:

The cat has had several bowel movements recently that are more firm but still runny at the end. However, she is scooting more.

Due to me HAVING to be away at Christmas (I had no choice in the matter), I missed giving her the appetite stimulant two days in a row. I'm nearly 100% certain that those pills were causing the bulk of the unsteadiness and odd mannerisms that I saw, not the Metronidazole as the vet suspected. Though there are still very mild neurolgical issues still present.

I can't comment on her appetite without the pills. It's still too early to say. She seems hungry, but doesn't like the food choices (canned or dry). I was told not to change her food, so I'm not sure what to do. What does it mean that her stools are firming up while on Fortiflora and Cyproheptadine?

I have to say that I think it's a waste of time and money to see the specialist without knowing WHY the vet wants me to go there. Shouldn't she give me her specific reasons for wanting me to go there? Don't I have a right to know? The general and vague answer that the techs gave me was not an answer at all. Should I call and leave a message for the vet to call me? It seems like time is of the essence and all they seem to be doing is jerking me around. I'm actually a bit shocked at the behavior from this vet. She's the type of person that can admit when she doesn't know something. So right now, her behavior has me feeling like she's hiding something. I've also requested copies of the records numerous times via email, phone, and in-person and they haven't even sent me half of what I asked for.

I don't know why we can't just try either Prednisolone or Budesonide/Entocort for a short while to see what happens. If the vet is concerned with the possibility of infection, then we could try the Metronidazole again or some other antibiotic before the steroids. I also don't see why the vet can't consult with someone about the heart issue. If it's not serious enough to warrant the use of medication, then a trial course of steroids should be fine, shouldn't it? I don't see why there should be any issues unless she's hiding something from me.

kh2b1 said:

Update:

The cat has had several bowel movements recently that are more firm but still runny at the end. However, she is scooting more.

 

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Why don't you ask to speak to your primary vet today on the phone and address these questions with her.There should be clearly articulated reasons why she wants you to see another vet, even if that reason is "I can't figure this out myself".

I can't answer many of the "why" questions since I am not a vet, but I agree with @StephenQ that a frank conversation with your vet is warranted. If it were me, I'd come right out and ask, "Why do you want us to go see an internal medicine specialist?" In fact, I'd probably come right out and ask all the questions you are asking here. I'm sorry you're frustrated and that you feel like you're getting jerked around.