Kitten diarrhea that just won't quit - even after treatment

I got a kitten from a shelter about three weeks ago. She has had diarrhea pretty much the whole time. There have been a few more solid looking poops, but mostly diarrhea.

She has been dewormed a bunch of times. Just to be safe, the vet gave another round of deworming pills - the last one she takes today, but this is I think the third time she's been dewormed in her 4 months of life.

As the poop wasn't quitting, the vet tested for Coccidia - test came back negative.

He gave us a medication called Metronidazole, which is supposed to help treat diarrhea and  Giardia, and told us to see how she is after taking that. Tomorrow will be her last day on it, and it hasn't helped. She had diarrhea on the floor overnight. 

We also put her on intestinal friendly food. No matter what the food, she loves to eat and she isn't dehydrated. She has gained a bit of weight since we've had her.

Anyone have any ideas of things I should ask the vet about when we go back?

Was a fecal sample sent to an outside lab for more extensive testing? The in-house tests done at the vet's office don't cover some possibilities like
Tritrichomonas foetus or E coli. Giardia may require more than one course of antibiotics, too. It's possible that your vet will pause the Metronidazole for several days and then prescribe a second round of it.

They did the fecal testing in house. Because other than the diarrhea, she seems to be in good health (although she has also had a sneeze for the last three weeks), they just tested for Coccidia and since it was negative, thought it would be more cost effective to see how the treatment goes before doing another round of any more testing.

He said if it doesn't work, they could do more extensive testing, but that it gets pricey very quickly and the test may not even come back with anything.

It's frustrating because I went through a lot of trouble when we first got the kitten, as we wanted to keep our first cat safe. Now our first cat has caught the sneeze. I don't want her to catch whatever is causing the poop issue, but I also can't keep the kitten closed off in the bathroom all day for weeks on end. She comes out to play, but they eat and poop in separate closed off rooms. Do you think this is ok?

I went through the metroni(however you spell it), the special food from the vet and eventually a lot of expensive tests. 

 If you search on here for IBD and limited ingredient diet on TCS you'll find a lot of info. 

So in short I followed the advice here and now he's doing great:

1.  Put him on a grain free limited ingredient diet with one type of meat (we went through duck, lamb and finally he would eat the turkey)

2.  I used fortiflora to get him to eat the food at first (just a sprinkle)

3.  You can also use the freeze dried raw food as a chaser (e.g., Stella and Chewy's or Primal) - this is the most recent discovery for me, wish I could feed him this 100% but it's too pricey.

Oh and he gets a little bit (.5 tablet) of prednisolone, but I'm honestly not sure he needs it anymore. 

Hope that helps and good luck!

PS He's about 18 months now but he had the runs from the time he was very small, so it can start when they are kittens.  Took about a month for the symptoms to completely resolve.

catzorz said:

 
They did the fecal testing in house. Because other than the diarrhea, she seems to be in good health (although she has also had a sneeze for the last three weeks), they just tested for Coccidia and since it was negative, thought it would be more cost effective to see how the treatment goes before doing another round of any more testing.

He said if it doesn't work, they could do more extensive testing, but that it gets pricey very quickly and the test may not even come back with anything.

It's frustrating because I went through a lot of trouble when we first got the kitten, as we wanted to keep our first cat safe. Now our first cat has caught the sneeze. I don't want her to catch whatever is causing the poop issue, but I also can't keep the kitten closed off in the bathroom all day for weeks on end. She comes out to play, but they eat and poop in separate closed off rooms. Do you think this is ok?

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yes. if they don't share a litter box, the intestinal bacteria won't be able to transfer (by stepping in it and licking it off). does the younger cat with diarrhea always make it to the litter box?

We had this problem with our kittens and we were freaking out. Had all the tests - including fecal - run and nothing. We stuck with ONE grain free, guar/carrigeenan free food and kept them on that ONE canned food and the problem resolved itself after about two weeks. We also found that pumpkin and florastore helped. 

catzorz said:

 
I got a kitten from a shelter about three weeks ago. She has had diarrhea pretty much the whole time. There have been a few more solid looking poops, but mostly diarrhea.

She has been dewormed a bunch of times. Just to be safe, the vet gave another round of deworming pills - the last one she takes today, but this is I think the third time she's been dewormed in her 4 months of life.

As the poop wasn't quitting, the vet tested for Coccidia - test came back negative.

He gave us a medication called Metronidazole, which is supposed to help treat diarrhea and  Giardia, and told us to see how she is after taking that. Tomorrow will be her last day on it, and it hasn't helped. She had diarrhea on the floor overnight. 

We also put her on intestinal friendly food. No matter what the food, she loves to eat and she isn't dehydrated. She has gained a bit of weight since we've had her.

Anyone have any ideas of things I should ask the vet about when we go back?

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Outside testing is not that expensive and certainly cheaper than treating the wrong condition.  PCR testing is essentially definitive as it is dna testing of the sample. As mentioned above there are other parasites besides giardia and coccidia.  You may want ti discuss with your vet withholding all food for 24 hours and then introducing boiled chicken.

Reba said:

 
I went through the metroni(however you spell it), the special food from the vet and eventually a lot of expensive tests. 

 If you search on here for IBD and limited ingredient diet on TCS you'll find a lot of info. 

So in short I followed the advice here and now he's doing great:

1.  Put him on a grain free limited ingredient diet with one type of meat (we went through duck, lamb and finally he would eat the turkey)

2.  I used fortiflora to get him to eat the food at first (just a sprinkle)

3.  You can also use the freeze dried raw food as a chaser (e.g., Stella and Chewy's or Primal) - this is the most recent discovery for me, wish I could feed him this 100% but it's too pricey.

Oh and he gets a little bit (.5 tablet) of prednisolone, but I'm honestly not sure he needs it anymore. 

Hope that helps and good luck!

PS He's about 18 months now but he had the runs from the time he was very small, so it can start when they are kittens.  Took about a month for the symptoms to completely resolve.

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BellaLuna777 said:

 
We had this problem with our kittens and we were freaking out. Had all the tests - including fecal - run and nothing. We stuck with ONE grain free, guar/carrigeenan free food and kept them on that ONE canned food and the problem resolved itself after about two weeks. We also found that pumpkin and florastore helped. 

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I just want to add to this.

As far as switching to a grain free food goes, its a good idea to mix it with what your cat usually eats at first.  Going suddenly from a low protein food to a high protein can cause some stomach problems.  That being said, when you switch foods, don't worry if the problem doesn't immediately go away, that is normal.  Sometimes though, major improvement can be seen in as little as a week, and sometimes even less.

Another problem that some people encounter when switching suddenly to grain free, is that their cats aren't used to the richness of the food.  These foods are much lower in fillers, and there for much richer.  Cats who aren't used to that sometimes will throw it up if they eat a lot right away (imagine how you feel after a rich piece of cheese cake).  And sometimes they'll just refuse to eat it at all.  So mixing it in for a week or so (at first replace 1/4 of the old food with the new, then 1/2, then 3/4, then all) slowly gets them used to that and is sometimes what needs to be done for the pickier individuals.

Another option is to use a transitional food that has less filler than the food your cat eats now, but more than grain free foods, so its right in-between.  This would be a high quality food with some grain, but instead of corn and wheat and processed by products of corn and wheat, brown rice or oats will be used as the filler (which won't break down into sugar as much) AND their will be a higher meat content.  Look for meat as the first ingredient.  Sometimes mixing is still required if you have a very picky cat who won't accept new foods easily.  

Also sometimes a completely grain free food isn't necessary.  There are some like blue buffalo and nutrisource that have high quality cat food, with rice as the only grain.  Some cats just cant have grains like corn and wheat (which are common fillers in lower quality foods, check the ingredient list, always!).  If thats what you want to try first, a small bag is best in case it doesn't have much of an effect, and then it will be easier to switch to a full grain food from there if needed because the higher quality, higher protein food with brown rice will have served as and transitional food.

Other things could be giving you clues that a certian grain is the culprit (though not always).  Itching when there are no fleas, biting or licking the paws frequently, excessive shedding, grimy film on the coat, and more.

These are things to look out for if you decide to try a high quality food with grain (and really just in general).  If these persist or begin while on this food especially after other symptoms have subsided or (in your case diarrhea), then I would absolutely suggest switching to a grain free food because your cat could be intolerant of ALL grain, this is not uncommon, but often isn't realized.

If these problems STILL persists (though this is far far far less common), try a different meat, make sure potato or other another starchy ingredient isn't used as a substitute filler for grain.  Your cat could have a allergy to a certain meat or may not be able to process sugars well.

And I agree that adding pumpkin puree (not the pie mix, careful they look the same!) and a probiotic will be beneficial during the food switch (and really just in general).  Fruitables makes a pumkin puree for cats and dogs that also has added vitamins and a few other beneficial fruits and vegetables.

I know that was a lot of information at once, and it may have come out sounding kind of jumbled and confusing, so if you have any questions or need me to break anything down, you can let me know on this thread or in a PM.

But please trust us that this isn't just all natural hippie mumbo jumbo.  This simple diet change could very well be the solution to stopping your cat's discomfort.  I have  helped customers with this exact issue solve this problem permanently with a diet change.  No vet bills, just better food.  Your vet may not realize this because nutritional courses are not required for vets, they are only voluntary.  Ask your vet if he/she has any nutritional courses under his/her belt.  If not, it may be wise to find one who does (or at least does a lot of research on diet), because many health problems can be related to diet.

The higher quality foods are a little pricier, but worth it for the health and happiness of your feline friend, plus preventing unnecessary vet bills.

Also at this point with how many times you have dewormed and all the tests so far being negative, it seems unlikely that the problem is a parasite and far more likely that its dietary. 

Annnn said:

Also at this point with how many times you have dewormed and all the tests so far being negative, it seems unlikely that the problem is a parasite and far more likely that its dietary. 

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The OP has stated that they only tested for coccidia, so the possibilities have hardly been exhausted and the assumption that the problem is dietary is premature. It may be, it may not be.

jcat said:

The OP has stated that they only tested for coccidia, so the possibilities have hardly been exhausted and the assumption that the problem is dietary is premature. It may be, it may not be.

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They also stated that the cat has been dewormed for the 4th time.  When someone says their pet has been dewormed I assume they mean from all the most common parasites unless they specify (though maybe I shouldn't).  I did not say for certain that it was.  I just said that it seems very likely.  Every time except for one that this problem has come up with a customer of mine, it has turned out to be dietary, and at this point I can't even count how many times someone has come to me with this issue.  Not saying that it can't be a parasite, it certainly can be caused by a parasite.  What I am saying is that it clearly is much more commonly a dietary issue.  And, it certainly doesn't hurt to do a simple diet change and see if the condition improves.

If the vet ends up not being able to find out what is wrong, I just would like the OP to know how frequently problems like this turn out to be diet related so that they are more likely to try a food switch, hopefully solving the problem.

*3rd time, not 4th

There has been more medical and nutritional discussions here but as @jcat  indicated (and to which i want to give emphasis) given that this is a) a kitten and b) came recently from a shelter, the odds are overwhelmingly in favor of it being a medical problem and not a nutritional one, more specifically a parasite that is so far undetected.  IBD in a young kitten while not impossible is very unlikely as its much more associated with middle aged or older in cats.

While that may be true, is there a downside to trying the nutrition fix first?

Reba said:

 
While that may be true, is there a downside to trying the nutrition fix first?

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@Reba

There is nothing wrong with a dietary approach if done at the same time as a medical approach but YES there is a downside to doing a nutrition "fix" before attempting a medical fix.   Those downsides include:

1- It's in the reverse order of what is most likely the cause with the result being that the owner is most likely delaying an effective treatment and causing the cat to be sick for longer, not in keeping with approved vet practice.

2- This delay can a) cause the medical fix to be more complicated, longer to fix, and more expensive, b) puts the kitten at added (new) medical risks including death (young kittens with untreated parasites can die of intestinal failure, i have personally seen this, and btw when it kills them it happens fast with little warning) and c) puts the kitten at added risk later in life for IBD, a complicated and potentially expensive and incurable bowel disease (see my cat Simon's memorial on the crossing the bridge forum at http://www.thecatsite.com/t/292577/i-have-lost-my-simon-after-15-years)

But there is nothing wrong with starting nutritional support, and in fact its probably a good idea to start working on nutritional support while attempting a medical fix.  Regardless of the cause, the kitten's intestines are inflamed/unhappy, shedding cells, potentially with bleeding, and a very gentle food, that is easy to digest would be a good thing, foods like human baby food stage one chicken is a classic example of what is used by the medical and sheltering communities for helping cats with transitory diarrhea.

The added benefit of short term stage one baby food use is that since the only ingredients are chicken and water, it eliminates every possible other ingredient related cause of the diarrhea.  Even the "best" fancy or prescription commercial foods generally have a LOT of ingredients, and the only way to eliminate them as a possible cause is to eliminate them from the diet.

Well just to expand a bit, I ended up with a cat with horribly bloody diarrhea after he was put on (and almost immediately taken off) compounded prednisolone.  The pred was prescribed after three months of metrodiazole and purina EN with little improvement.  So when the blood D started I ended up shelling out a grand for tests.  He was very sick, could barely move and had to eat standing up.  I'm firmly convinced that I probably could have just done the novel protein/grain free thing and I would have avoided both the cost and his suffering.

I do understand that the fact that the kitten came from a shelter increases the likelihood that it is indeed a medical problem.

If she can just get an inexpensive fecal tests that tests for the other parasite I'd do that, but from what I remember the sample had to be obtained at the vets office and the drug to treat it was prone to cause serious side effects.  

Coccidia and giardia are the most likely culprits in shelter kittens.False negatives when doing in-house testing for the latter aren't uncommon, so it's often repeated after a few days. Tough cases may require multiple treatments with antibiotics and dewormers. The vet may also simultaneously recommend a prescription or limited ingredient diet and hygienic measures like steam cleaning or bleaching litter boxes and surfaces. The local shelter recently had 10 kittens from one source (siblings, half-siblings and presumably cousins) with giardia, and it took a couple of weeks to get it cleared up.

Although IBD is unlikely in kittens, it's possible. If you're really unlucky, you adopt a kitten with diarrhea caused by multiple things. Mogli had enterohemorraghic E coli, IBD and food allergies. He'd been successfully treated for coccidia prior to adoption.
Needless to say, it took a lot of testing, antibiotics, a biopsy, food trials and a special diet to get him healthy, and the IBD can flare up again at any time. Diet alone wouldn't have cured the EHEC, which is often fatal.

That kind of situation isn't common, though, so the first step is to identify and target any internal parasites.

Reba said:

 
Well just to expand a bit, I ended up with a cat with horribly bloody diarrhea after he was put on (and almost immediately taken off) compounded prednisolone.  The pred was prescribed after three months of metrodiazole and purina EN with little improvement.  So when the blood D started I ended up shelling out a grand for tests.  He was very sick, could barely move and had to eat standing up.  I'm firmly convinced that I probably could have just done the novel protein/grain free thing and I would have avoided both the cost and his suffering.

I do understand that the fact that the kitten came from a shelter increases the likelihood that it is indeed a medical problem.

If she can just get an inexpensive fecal tests that tests for the other parasite I'd do that, but from what I remember the sample had to be obtained at the vets office and the drug to treat it was prone to cause serious side effects.  

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@Reba I'm sorry you went through that but i think its important for the OP to have us address her specific concerns and using your cat's illness may lead the OP astray given the specifics of her situation. Yes we can absolutely apply the lessons of our own cat's illnesses to other cats here, but in your particular case, i think its apple and oranges.

By the way, did you ever get a diagnosis and what was the outcome?

PCR Testing (Polymerase Chain Reaction) for parasites amplifies the genetic material being tested, coccida, giardia and Tritrichomonas foetus as examples and insures a very high quality and accurate result - much more so than by in house testing. it is NOT expensive compared to many other things and the results come back in 2-3 days. Details below.

https://www.idexx.com/small-animal-...ces/reference-laboratories/realpcr-tests.html

http://vetmed.tamu.edu/gilab/service/assays/tritrichomonas

Ah Found it.  This is what I was looking it when I was thinking about whether he should be tested.   I saw that the test wasn't that expensive, but what I remembered was this that you needed a fecal loop (i.e., veterinarian) to collect it otherwise the test was relatively unreliable,  That isn't mentioned in the documentation from the test manufacturer, but it is here (see page 6):  http://www.cvm.ncsu.edu/docs/documents/ownersguide_tfoetus_revised_122009_final.pdf

Perhaps this is what her vet meant when he told her it would get relatively pricey to do the test.  Or maybe he's not even familiar with it (never came up in the two vets I brought my cat to.) 

What I was picking up on in her post was her concern about the cost, to me that's more of a barrier to treatment than people not understanding what they should do.  I don't doubt that it may be apples and oranges here, it's just that a lot of people only have a choice of apples.

To the OP, @catzorz, I think a two pronged attack is needed.  You probably should go ahead and have your kitty tested for giardia, coccidia (again), and tritrichomonas foetus.  In addition, you can also make some dietary changes that might help no matter the outcome of the tests. 

http://vetmed.tamu.edu/gilab/service/assays/tritrichomonas

I have a cat who cannot tolerate any Wellness grain free food.  We hadn't given him any since he was about 7-8 months old (he's 4 now), but we introduced it to all our kitties' diets about a month - 6 weeks ago.  Sure enough, he had the runs and inflamed intestines.  We eliminated that canned food, put him back strictly on the EVO wet and his Rx food, Royal Canin Gastrointestinal HE, and his poops firmed up in about 2 days.  We also started him back on his supplement, Missing Link, which has a good amount of Omegas in it that help with inflammation.  We tried to give him the Metro in pill form, but he would have none of that!  So far, so good and it's been a week of good, solid, foul-odor free poops!