Blood in Poop Part 2

Hi friends,

A little over a month ago, you guys were giving me advice on my kitty who continuously had blood in her poops.

The vet said it was likely colon inflammation and put her on a week of Tylosin. We also gave her some Fortiflora. During that week, I didn't see her poop at all.

The blood is back now. Just a couple of drops at the end of some poops, but not every poop. The vet has suggested putting her on Tylosin again for two weeks or changing her food to a high fibre diet for five weeks to see if that helps (suggested a prescription Royal Canin food).

What do you guys think we should do first? Is the Royal Canin high fibre prescription a good food? She's been on a low phosphorus food to help with urinary crystals, and I don't know if this would have a higher phosphorus amount.

What would you guys do first? Any tips?

catzorz said:

What do you guys think we should do first? Is the Royal Canin high fibre prescription a good food? She's been on a low phosphorus food to help with urinary crystals, and I don't know if this would have a higher phosphorus amount.

What would you guys do first? Any tips?

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Nah that isn't good food. What food are you feeding right now? Blood in stool is typically food related. Try some easy to digest wet foods. Weruva have several that are low phos. 

Thank you for the reply! We have been feeding her Royal Canin Adult Fit wet food since probably September. We tried getting her on Weruva (I love the idea of feeding her REAL food) but she wouldn't eat it at all. She's really picky and likes the tiny chunks of mystery meat in gravy type deal.

catzorz said:

 
Thank you for the reply! We have been feeding her Royal Canin Adult Fit wet food since probably September. We tried getting her on Weruva (I love the idea of feeding her REAL food) but she wouldn't eat it at all. She's really picky and likes the tiny chunks of mystery meat in gravy type deal.

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It's more than likely the food. If you have a cat that's picky with wet food you just have to try several different varieties/textures. Not really necessary for her to be on low phos food for urinary issues. If you can get her on an all wet food diet that's usually sufficient for cats with urinary problems, low phos is really only relevant when a cat has kidney disease. 

In the mean time you could start giving her some slippery elm syrup, which is great for both diarrhea and constipation (also good for urinary health!), will give some added fiber, and soothe her tummy. I make into a syrup and syringe, but some of my cats will lick it up mixed into baby food. Additionally, you could start giving her some digestive enzymes, this is a good one.

http://www.littlebigcat.com/health/slippery-elm/

https://www.chewy.com/animal-essentials-plant-enzyme/dp/49372

She's always been on mostly wet food only. She shares three cans a day with our other kitty. We have dry food out, but she's not really a snacker. Do you know of a few good wet food brands to try out and see if she'd like them? Something I guess high fibre/low phosphorus (even that's even a combo that exists).

C catzorz when you said "The vet said it was likely colon inflammation and put her on a week of Tylosin. We also gave her some Fortiflora. During that week, I didn't see her poop at all." Do you mean she didn't poop for a week, or that you didn't see blood in her poop?

I don't know about the low phosphorus for cats with urinary problems, but I did think it was important to keep certain minerals down, and to avoid fish because of this.
With our cat Pushy, we sorted his recurrent crystals with the Hills rx diet, then switched to other brands of wet. He hasn't had issues for years now on a 90% wet diet. We add pysllium every day to help with his loose stools.

I didn't see her poop during that week. She is usually really regular and goes as soon as I get home from work every day, but she didn't poop during the evenings that week. She may have been going at a not regular time during the day...but I have two cats so I couldn't be sure whose poop was in the litter box from during the day.

Because it's a fairly complex situation with two health issues each possibly treated/prevented through diet, I think following your vet's advice is the safest bet at this point. Please, any advice given here, or elsewhere on the internet, should be taken with a grain of salt. Consult with your veterinarian again before making any changes or adding any supplements. If you're still not sure, ask for a second opinion from another vet - possibly a nutrition specialist. You can find qualified ones here: http://www.acvn.org/

Good luck and let us know how she's doing!

Thanks for the reply! I guess I should probably also put the disclaimer out there that any advice I receive here would of course be discussed with the vet before getting put into action. I just feel like the vet sometimes points you in only one direction (expensive perscription food that might not actually be all that healthy) rather than outright discussing all of the other options (natural supplements or other foods)...likely because they get paid to push the percription diets. But yes - any advice will of course be discussed with the vet first - it's just a matter of knowing what to bring up (because I am kind of lost).

Other than Weruva, are there any other brands of food that are more natural/human grade without unnecessary fillers that I could look into?

catzorz said:

 
Thanks for the reply! I guess I should probably also put the disclaimer out there that any advice I receive here would of course be discussed with the vet before getting put into action. I just feel like the vet sometimes points you in only one direction (expensive perscription food that might not actually be all that healthy) rather than outright discussing all of the other options (natural supplements or other foods)...likely because they get paid to push the percription diets. But yes - any advice will of course be discussed with the vet first - it's just a matter of knowing what to bring up (because I am kind of lost).

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You nailed it. That's exactly the issue many of us have with veterinarians. Like doctors, many vet's don't go through very much nutritional training, especially for cats. I've learned more about cat nutrition from "self proclaimed" nutritional experts than i have from any vet I've ever seen. 

Food that I like other than Weruva are Tikicat, Merrick LID, Feline Naturals, Ziwipeak, and freeze dried foods like Stella and Chewy, Primal, Northwest Naturals, or Instinct Raw Market. You can find most of these at independent pet stores or online. Feline Naturals and Ziwipeak are not cheap, but they're good foods. I use those two in my cats night snack rotation, the rest of their meals are raw.

Really, to find the best food, it's a matter of reading the ingredients on the can, determine if they sound good, THEN testing it with your cat to see if she'll eat it.  The best food in the world is useless if she won't eat it

This article should help you determine what type of ingredients to look for:  http://www.thecatsite.com/a/what-makes-the-best-canned-cat-food

Now, if all you need to do is add a little fiber for a few weeks, you could try adding in some plain cooked pumpkin.  It's a great source of fiber.  One teas. up to 3 times per day, just mixed into her favorite wet food, so you can mix it into her current food if you want.  YOu can used canned pumpkin as long as it just plain pumpkin, not pumpkin pie mix. 

Just waiting on a call back from the vet to see if adding pumpkin would be as good as switching to a high fiber prescription diet.

For the amount of phosphorus in the food, I've been looking over this chart:

https://scontent-ort2-1.xx.fbcdn.ne...=898a480b4979f7d951ff859b0a0c163d&oe=58D87614

It looks like Wellness (some types) is a bit lower in phosphorus than the food we are giving her now, so that might be a good choice for a new food to try. Merrick is also available at the store around here, but the amount of phosphorus is so high. Natural Balance is around the same amount of phosphorus as the food we currently give her. How do you feel about Wellness and Natural Balance?

Update: talked to the vet. He said we can try adding canned pumpkin to her food, but there's no definitive answer about HOW MUCH pumpkin to add/how much is good for her. He also said that we could try adding fiber to her food and that we could use one teaspoon of Metamucil to each can. I thought metamucil had sugar or sucralose in it, which I assume wouldn't be good? Also I thought high fiber was used to treat constipation....our cat is having soft poops and isn't struggling to get them out. So I'm really confused about why this is the way the vet is leaning. Ugh.

His suggestion is to try the Royal Canin prescription high fiber canned food and to keep her on it for the long term.

Great news! Our girl likes the canned pumpkin! I mixed a spoonful into her regular wet food today, and she gobbled it up.

I also tried a couple of new canned foods recently: wellness core (she hated it - won't touch pate) and Pride by instinct (tried it out because it has a higher fiber content - she loved it). I don't know about giving her Pride long term though because it seems to be filled with a lot of veggies and carbs? It sucks that I can't get her to eat good food. She will only go for minced in gravy, and everything healthy that I find is either pate or the chunks are too big for her.

Glad she likes pumpkin.  Yes, Merrick is really high in phosphorus.  I had a kidney cat who really like some of the Merrick foods, naturally   But our Vet said to go ahead and let her eat them as part of her rotation, since other of the food she ate was pretty low in phos.  She figured it all balanced out in the end. 

The link to the chart you provided only lead me to a picture and I didn't find a chart,but I DO have this chart:  http://www.felinecrf.org/canned_food_usa.htm#canned_usa  Its in order of the amount of phos in the food, which can be helpful.  I found, though, when trying to find a food that matched all the criteria I wanted (low carb, low phos, etc.) AND they my girl likes, those were few and far between

I don't understand it myself, but pumpkin helps with both diarrhea AND constipation. 

I'm so upset! Over the last couple of days, she's has a couple of poops that were back to being lighter brown and more normal of a size (they had been getting kinda small). But just a minute ago, she had the one in the pic below (sorry for the poop pic). It's bigger than she's had in quite a while and there was more blood. Is this enough blood to need to rush to the vet? Even though the vet never does anything and just says to add fiber to her diet and see what happens...they haven't even done a poop test since she's an indoor cat. Please let me know if this is too much blood.

Hmmmm...it's kind of a lot, and it's mucousy.  AND, since you mentioned your Vet has never ever done a fecal float now I'm wondering if this is not some sort of parasite rather than "colon inflammation" .  I just read your other thread (part 1) and noticed someone else had this same issue, and put their cat on a LOW fiber diet to resolve the issue.  Over in that thread there was a discussion about perhaps you getting a second opinion, and I'm wondering if you did that.  If not, is there some reason why not.  I think I would, especially if a Vet will not even discuss doing a fecal float with these issues.  Indoor cats can most certainly contract intestinal bugs  that can best be resolved with medication.   

I don't think this is an emergency situation, but would definitely try to get a fecal float done on her in the near future. 

Is there an undue amount of stress going on in her environment?  Stress can cause spotty blood and mucous in the stool.

If she has colitis, don't be constantly switching food on her - seek a new vet for a new opinion, test the stool for parasites and bacteria (these don't always show up on one test, sometimes it's necessary to time the testing), possible xray to look for GI inflammation.

Thanks for the replies, @mrsgreenjeens and @cat-tech.

We haven't received a second opinion yet. I am going to call the vet on Monday. I have asked them to do a poop test and even brought in a fresh one the first time we went in. They threw it in the garbage and said there's no reason to test it, which I felt weird about. I am going to tell them that I don't care if they think it's unnecessary, I want a poop test and an x-ray or ultrasound (I don't know which would be better for this situation). She had an x-ray in July, and I know it's not great to overdo x-rays. If they tell us to wait out the change in food again, I will go to a different vet for a second opinion. Like, I'd rather spend extra money to just figure out what is actually going on and get it dealt with rather than drag this out. I just want to make her better.

catorz,

The fiber helps maintain motility, but a hypoallergenic dietary trial should be the first choice (this can often rule in or out, dietary sensitivities to certain ingredients or proteins) in treating colitis.

I don't know why your vet refuses to do a fecal test or culture, this would be the second step (ideally, should be done in conjunction with blood work) in determining inflammatory condition vs dietary sensitivity/allergen vs parasitic infection vs bacterial infection.  Press him on that.  Blood work, particularly a CBC can show inflammation or eosinophils, which can help determine allergens vs inflammatory conditions.

Most important is monitoring the diet because of her history of urinary crystals.  You don't want to rock that boat.  You have nothing to lose by trying a hypoallergenic diet and I think that's what your vet is trying to tell you.