Diarrhea for 8 months now

karenh · Dec 22, 2015

StephenQ said:
Can you tell us where you are?

If you're confused then we're confused. One can't judge the value of Pred without weights for the cat prior to giving the pred and after. At the very least you need to see weight gain during the course of the pred to judge that its working.

This is as clear a "flow chart" as I can make:

1- Cat has long term diarrhea and/or vomiting with no obvious medical cause, all easily testable causes are ruled out.

2- Vet makes a presumptive diagnosis of IBD because there is really nothing else to diagnose, but disease is mild, no weight loss.

3- Various treatments are tried (Tylosin, Metronidazole, B12, pepcid, and food trials over many months, etc), and they either work long term or not but eventually if they stop working then:

4- Cat starts to loose weight. Disease has become serious/severe. Decision is made to Biopsy or not. Ultrasound probably reveals thickening of intestine with loss of layering. IBD or Small Cell Lymphoma is strongly suspected. And even without a biopsy, or even without an ultrasound see #5 below.

5- Because of #4, cat is put on Prednisolone. If weight starts to gain in 1st or 2nd week (even measured in ounces) then this helps confirm diagnosis of either IBD or SCL, and cat stays on Pred because the Pred is keeping the cat's disease in remission until #6 below. *Note: if initial dose of Pred doesn't help then an increase in dosage is worth trying.

6- Pred stops working, weight loss and possibly serious GI issues return, other drugs are tried and either they work or #7 below.

7- Cat dies or is PTS (Put To Sleep).

IMO, if any of the above is skipped or not understood, then there is confusion, and the potential for inadequate or incorrect diagnosis and treatment.

Prednisolone doesn't have any specific issues with kidney problems. Pred can cause diabetes so that needs monitoring, and because it has the potential to lower the immune system, blood values need regular re-checks. But with severe IBD or SCL, all the risks of Predisolone are worth it because the alternative is #7 above.

I've been through all the above through #7, so I've really been there.

Hi, I appreciate what you have stated here however, my cat has diarrhea for 8 months now and nothing is working. Not even the Pred. He has been on Flagyl and then zeneqiun, then panacur, and currently on pred for last 2 months. I changed his diet to grainfree about 4 weeks ago and put foriflora in it ,and still no improvement. Diarrhea is only once a day., but he has pain when he goes. He cries. I can't figure out what is wrong. He is a healthy 20lbs cat. Bloodwork is normal. Dr wants me to bring him in for another blood test for some digestive test. No vomiting. Do you have any suggestions?

stephenq · Dec 22, 2015

KarenH said:
Hi, I appreciate what you have stated here however, my cat has diarrhea for 8 months now and nothing is working. Not even the Pred. He has been on Flagyl and then zeneqiun, then panacur, and currently on pred for last 2 months. I changed his diet to grainfree about 4 weeks ago and put foriflora in it ,and still no improvement. Diarrhea is only once a day., but he has pain when he goes. He cries. I can't figure out what is wrong. He is a healthy 20lbs cat. Bloodwork is normal. Dr wants me to bring him in for another blood test for some digestive test. No vomiting. Do you have any suggestions?

OK well you can't do a biopsy while he's on pred but since the pred isn't working, one option would be to take him off the pred for the recommended time, and then do a surgical biopsy of his intestines to try and get a definitive diagnosis.

Perhaps prior to that I think i would definitely get an ultrasound if you haven't had one done prior because if they can see thickening of the bowel then that tells you basically that is either IBD or small cell lymphoma.

And since nothing has worked, and assuming your vet thinks its IBD, then another step would be to start Leukeran, which is more for small cell lymphoma but also helps with severe IBD, and while not all vets will prescribe without a diagnosis of SCL, many will especially when nothing else is working.

The one obvious thing that you haven't tried it seems is a novel protein diet like venison, rabbit etc that many cats with IBD do NOT react to and therefore don't get diarrhea.

So to re-state in a slightly different order.

Assuming vet thinks its IBD

- ultrasound. If thickened bowels then:

- either try a novel protein diet OR

- stop pred and then do biopsy OR

- Go straight to Leukeran

I'm assuming all other testing has been done including PCR testing of the stool to 100% rule out a parasite including Giardia, Coccidia and Tritrichomonas foetus which is not often tested for. PCR testing is sent out, its probably about $75, and it is the most accurate test fort stool and given what you've been through i would not reply on in house flotation tests.

You could also do a PLi test for pancreatitis (http://www.vcahospitals.com/main/pe...ancreatic-lipase-immunoreactivity-in-cats/362)

A good site on parasites is http://www.2ndchance.info/parasite-cat.htm

Great site on IBD is at http://www.ibdkitties.net/

Lastly, is his weight stable? Severe IBD/SCL in cats causes weight loss if treatments aren't working so tracking his weight weekly is important. A baby scale would do this, along with a log kept by you/

karenh · Dec 22, 2015

Thanks so much for this info. I will take this info to my vet and get these tests done. His weight is going up. He weighed 18lbs when this started and now weighs about 20lbs due to the pred. Made him more hungry.

Do they have to anesthetize a cat for the ultra sound?

I will not anesthetize him because I lost my last sweet cat to anesthesia. He died on the table. Very traumatizing for me.

stephenq · Dec 22, 2015

KarenH said:
Thanks so much for this info. I will take this info to my vet and get these tests done. His weight is going up. He weighed 18lbs when this started and now weighs about 20lbs due to the pred. Made him more hungry.

Do they have to anesthetize a cat for the ultra sound?

I will not anesthetize him because I lost my last sweet cat to anesthesia. He died on the table. Very traumatizing for me.

Well even if the diarrhea isn't under control the fact that he's gaining weight is evidence that its helping. Cats with IBD don't gain weight just because they get hungrier, their intestines are incapable of absorbing enough nutrients to gain no matter how much they eat so the weight gain is a good sign. It also helps with a diagnosis and to be honest, given what you've described and the medications used, its unlikely to be a parasite at this point.

Your cat does not need to be anesthetized for an ultrasound, its painless like looking at a fetus in a pregnant mom, in cats they just shave the fur, rub jelly on the stomach, gently hold the cat and rub a wand over the jelly to get an image.

karenh · Dec 22, 2015

Thanks for clarifying the ultrasound procedure. I think all signs point to IBD or a food allergy or both, but I am going to get the digestive blood test done first to rule out pancreatitis. Thanks so much for your help, I really appreciate your time and I will let you know how the blood test turns out.

stephenq · Dec 23, 2015

KarenH said:
Thanks for clarifying the ultrasound procedure. I think all signs point to IBD or a food allergy or both, but I am going to get the digestive blood test done first to rule out pancreatitis. Thanks so much for your help, I really appreciate your time and I will let you know how the blood test turns out.

OK. Mind you, i was throwing some "darts" at your cat's condition, chronic diarrhea by itself doesn't sound like pancreatitis, usually you get vomiting and pain on palpitation of the abdomen, and pancreatitis usually has flare ups, then gets better, the the PLi test is most accurate during a flare up.

Assuming other diagnoses had been properly ruled out if it was my cat i think my next step would be an ultrasound. But all that can do is tell you that its probably IBD or SCL, but it can't distinguish between the two.

karenh · Jan 14, 2016

Well I am so happy today! My cat had a normal BM. First one since March of last year. Here is what I am doing:

I switched his food to grain free about 2 months ago, canned food. I am feeding him Nutro canned pate. Also, I stopped all fish, as he has terrible diarrhea when eating this.

I put Fortiflora on every meal 3x a day.

I give him one half or 2.5mg of prednisone pill daily at dinner. He has been on this for about 3 months. Although it did not stop the diarrhea, I continued to give it to him.

I have a call into the vet to see how she thinks we should proceed with the prednisone.

Wow, this has been a long road and at times I was very discouraged and worried that something terrible was wrong.

For those of you in a similar situation, all I can say is be patient. Instant results from medicine etc is not always possible.

Diarrhea for 8 months now

karenh

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