Sebastian is Back at the Vet...Suspected Pancreatitis Again :(

[violet]

GoHolistic, I'd just like to ask one question.  When was the last time Sebastian had the fPLI test?

 

[denice]

I probably would go with another round of flagyl but I tend to lean toward conventional medicine.  The thing is there is no one right answer and each cat is different.  When I was trying to figure out what would help Patches I was doing a lot of vet hopping and trying different holistic things.  The vet who finally figured things out is a conventional vet so that is probably why I lean toward conventional medicine.  If the S.Boulardii is actually a yeast you should be able to give it along with the antibiotic.  I think I have read about that combination for bacterial overgrowth.  Of course that means the poor kitty is going to be taking two bitter tasting things.

 

[jcat]

I'd tend to say yes. We went with a 10-day course of an antibiotic (Marbocyl, which is a successor to Baytril) to knock out the E coli. We had a diagnosis of neutrophilic IBD and probable food allergies. The antibiotic was along with a nutraceutical (which unfortunately isn't available outside Europe) containing yeast extracts and mannan-oligosaccharides (MOS). IIRC, the stuff Carolina used also had MOS - Laurie should know. From what I understand, the MOS prevent bacteria from binding with epithelial cells. The antibiotic was given in the morning and the nutraceutical in the evening. He got the Entero-Chronic nutraceutical for three months and is now on another probiotic, but is supposed to go back on the E-C immediately if there's another flare up.

As for diet, it was/is unique proteins, gluten-free and preservative-free canned. I'm now very cautiously adding cooked meat (pork and beef).

 

[goholistic]

 
GoHolistic, I'd just like to ask one question.  When was the last time Sebastian had the fPLI test?

Hi Violet. Sebastian had the snap fPL around July 22 when he was severely ill and hospitalized for several days. The doctor said that was "very" positive without a doubt. I took him in on September 6 due to recurring vomiting throughout the night, so they did another snap fPL done and it came back negative. The spec fPL test (to be sent out) was never done.

 
I probably would go with another round of flagyl but I tend to lean toward conventional medicine.  The thing is there is no one right answer and each cat is different.  When I was trying to figure out what would help Patches I was doing a lot of vet hopping and trying different holistic things.  The vet who finally figured things out is a conventional vet so that is probably why I lean toward conventional medicine.  If the S.Boulardii is actually a yeast you should be able to give it along with the antibiotic.  I think I have read about that combination for bacterial overgrowth.  Of course that means the poor kitty is going to be taking two bitter tasting things.

Thanks for your opinion. I called the vet to confirm whether or not they gave him the Flagyl this past Friday (9/13) during his visit. They did not give it to him. I put in a request to have the doc call me. The pills are easy now that I have the gel caps. 

  I'll have to get smart about the S. Boulardii if he won't eat it in his food. 

 

[goholistic]

I'd tend to say yes. We went with a 10-day course of an antibiotic (Marbocyl, which is a successor to Baytril) to knock out the E coli. We had a diagnosis of neutrophilic IBD and probable food allergies. The antibiotic was along with a nutraceutical (which unfortunately isn't available outside Europe) containing yeast extracts and mannan-oligosaccharides (MOS). IIRC, the stuff Carolina used also had MOS - Laurie should know. From what I understand, the MOS prevent bacteria from binding with epithelial cells. The antibiotic was given in the morning and the nutraceutical in the evening. He got the Entero-Chronic nutraceutical for three months and is now on another probiotic, but is supposed to go back on the E-C immediately if there's another flare up.

As for diet, it was/is unique proteins, gluten-free and preservative-free canned. I'm now very cautiously adding cooked meat (pork and beef).

Thanks jcat. It seems a lot of the bacteria associated with neutrophilic IBD are things like E. coli, salmonella, etc. I don't know how Sebastian would have gotten anything like that. He's indoor only and doesn't eat raw. Could it be bacteria that his body is creating on its own, such as "idiopathic" IBO (intestinal bacteria overgrowth)? I did see a supplement that combines S. Boulardii with MOS. I think it's by Jarrow.

Again, the neutrophilic IBD is not an official diagnosis. It's just something I've been researching based on Sebastian's high neutrophil counts. Of course, upon more research, I found that high neutrophils can also mean cancer, but most references cite bacteria first. If it was cancer, wouldn't he be anemic?

 

[ldg]

Sorry, just going to jump in here. :lol3:

No, he would not necessarily be anemic if it's cancer. That CAN be a symptom, but isn't by definition.

Very simplistically... E. coli, salmonella, etc. are essentially "endemic" to the environment. If he's ever eaten dry food, for example, he's probably been exposed to salmonella. These - along with all of the other problematic strains of bacteria - are actually quite normal in the guts of animals (and people, actually). Normally our immune systems and healthy gut bacteria keep them in check. It is when our immune systems weaken for the million reasons they do, or something about our internal environment changes (which can simply be due to a change in food), that it is possible for the unhealthy bacteria to take over.

You don't need to choose between antibiotics and probiotics. You just need to give them at least 2 hours apart. The antibiotics will keep wiping out the bacterial-based probiotics, but as Denice says, the antibiotic will not kill the yeast-based probiotic (S. boulardii).

In fact, I see probiotics as supportive therapy TO antibiotics. :dk:

The Nexabiotic 20-strain has (basically) the same dose of S. boulardii as the Jarrow with MOS (5 billion CFU). As jcat points out, the advantage of including the MOS is that it improves the "performance" of the S. boulardii in out-competing the unhealthy bacteria. But if pilling is an issue (which it may not be any longer :cross: ), then the Nexabiotic 20-strain mostly likely will at least help, because it's usually palatable just sprinkled on food. The issue with the S. boulardii is that it does not "colonize" the gut in the same way bacteria-based probiotics do, so it is best given 2x a day. If using the Jarrow S. boulardii with MOS, then I would concurrently give an acidophilus probiotic. It just so happens that the Natural Factors acidophilus+bifidus is actually primarly L. rhamnosus, discussed in the article you provided about the role of bacteria in IBD.

And, actually, as the dose of the Jarrow S. boulardii needs to be divided in two, I actually had to use the Natural Factors in order to wind up with a reasonable assurance that the amount of S. boulardii was correct in the empty capsules I had to manually fill. Though... I guess I was using half the adult cat dose, because we were treating kittens. I bought the size 3 caps (via Amazon) and a manual filler from Cap-M-Quick website. http://emptycaps.com/size-3-cap-m-quik-capsule-filler.html Carolina also used this to split the Jarrow+MOS capsules in half, so she could give the correct dose AM and PM.

...and my understanding is that high neutrophils can simply be indicative of infection or inflammation - or even rise due to stress. :dk:

I know you're giving him the prescription food for now. :rub: But wasn't the raw rabbit he liked one of the brands treated with HPP? Because there are a number of sterile raw options now (just as a reminder ).

 

[goholistic]

Sorry, just going to jump in here.

No worries! I like when people jump in! 

Good thoughts about the bacteria. I see what you mean - the bacteria is always there, but some fight it off and balance it out better than others.

I talked to the doc just a little bit ago. She wants me to give the Flagyl (metronidazole) for three days (not sure if that's really doing anything) and reduce the Pred from 7.5 mg to 6.25 mg. I stopped the fiber he was on because a) I felt it wasn't doing anything beneficial for Sebastian at this point, and b) I read that bad bacteria can feed off of it (sorry, I don't have my reference).

I think what I'll do is give him the 5 mg of Pred and probiotics in the morning and 1.25 mg of Pred, 1/4 of metronidazole, and 1/4 tablet of Pepcid in the evening...all in a gel cap. 

  Since he's on metronidazole for only a short time, I'll replace that with an evening dose of probiotics.

Question about the Nexabiotic 20-strain with 30 mil CFUs...it does, indeed, have 20 strains but there are less CFUs per strain than say a 10-strain with a total of 30 CFUs. Is it still beneficial to have more strains but less CFUs? Also, I saw this product online - Ultimate Flora Advanced Immunity - which has the S. Boulardii and S. Cerevisiae (as in the Jarrow formula), but also includes Arabinogalactan, which I've read some good things about. Any thoughts on this product?

Yes, he is eating the prescription food. The canned prescription rabbit is actually not all that bad ingredient-wise, although the carrageenan is debatable. He liked the S&C freeze dried rabbit, but it is for dogs and so I could not feed that to him long-term. It also has vegetables in it, which I'm not sure if he has a sensitivity to or not.

 

[ldg]

No worries! I like when people jump in! 

Good thoughts about the bacteria. I see what you mean - the bacteria is always there, but some fight it off and balance it out better than others.

Exactly. :nod: And according to that piece you posted, some cats have a genetic ummm.... disposition? proclivity? well, genes that contribute to the problem.

Yes, the metro is often just a 3 day course. :dk: I use it on the ferals when it's apparent they've got diarrhea (I assume giardia. Does seem to clear it up, though sometimes we go 5 days. I just keep it on hand).

I like the plan.

As to the best probiotic to use... with IBD, I think it's really hit-or-miss. That's why there are some studies indicating XYZ probiotic helps; others where it doesn't. So is it better to hit it with a broad spectrum of probiotics of lower potency... or try higher levels with less spectrum? I really don't know. I think you give something a month, and if it's not helping, try something else.

FYI, the main reason I use the Nexabiotic is for S. boulardii in a palatable format. I'm not treating anything, so I want to be able to just sprinkle it on food and have them eat it. I don't like that it has so little of the rest of the strains. That's why I still use half the dose I was of the Natural Factors acidophilus+bifidus. Also, because I'm using it as a supplement, I use 1/2 of the dose of the Nexabiotic (I keep tweaking :lol3: ) vs what's recommended for treating various bad bacteria (the recommended amount for a cat is 5 billion CFU of S. boulardii. I now split one 5 billion CFU capsule between 4 cats, 2x a day, giving them 2.5 billion CFU of S. boulardii total daily).

As to the Ultimate Flora Advanced Immunity... I don't understand the label. I don't understand what's in it apart from the 10 billion CFU of S. boulardii? :dk: As I said, we do know that the effective dose in adult cats for treating at least C. perf, C. diff and Coccidia is 5 billion CFU - at least when combined with the MOS. That was the amount used in the C. perf study in cats, and the amount Carolina used that resolved the overgrowth in her kitties. I used a half dose for the kittens, and that resolved their coccidia. The kittens were only kept on it for a month (the amount of time in the published study); Carolina continues her cats on a half dose daily (split into two doses) as a preventative.

Ok, here's the link to the Ultimate Flora Advanced Immunity product on the manufacturer website: http://www.renewlife.com/advanced-immunity-probiotic-supplement.html#specs It's Renew Life! :doh3: I do know this is high quality manufacturer. :nod:

Yes - it's got the MOS. Good! I know echinacea is used in cats. As to the "Saccharomyces cerevisiae" derivatives, S. cerevisiae is brewer's yeast, which we know is safe for cats. And with 10 billion CFU, you can give 1/4 capsule 2x a day for a total of 5 billion CFU. :nod:

The fiber: I don't have a reference piece handy. I'm sure it exists though, because ANY diet recommended for people with dysbiosis and related leaky gut syndrome, candida overgrowth, etc. are ALL high protein, NO carb diets. There are candida diets where starches are slowly re-introduced. But with dysbiosis & leaky gut, the GAPS diet is very strict about no starches, no carbs. (And works well for our kitties. :lol3: ). Both recommend high doses of probiotics for a fairly long term. The goal is providing no substrate for the bad bacteria; keep replenishing the healthy bacteria, and just crowd out the bad stuff without giving it the opportunity to regrow - until the body heals enough (in people, the GAPS diet says it can take up to 18 months) to regulate with "normal" doses of probiotic supplement.

:dk: Just putting that out there.

...and I forgot it was the dog version. Yeah, that could be a problem, especially given the veggies, thus fiber content. ...IF the problem is IBD due to dysbiosis, and potentially leaky gut on top of it.

Of course, with the use of probiotics, it really isn't much of a health risk to try and see if it helps.

 

[goholistic]

Yeh, and Sebastian has that "sick kid" disposition it seems. After I adopted him, it took awhile to really get his URIs under control.

I still haven't decided on a probiotic, so I'm continuing to give him the one I have on hand. I opted not to get the one by Renew Life. I don't know if the same concept applies to cats, but I know with my autoimmune disease, immuno-stimulants (which include echinacea) are an absolute no-no. 

  They can throw immune cells into overdrive and cause inflammation.  I think echinacea may be good for use in cancer in cats, but probably not an inflammatory disorder. I know we don't know what Sebastian has, so that is why I have to consider all things.

Ah-ha! Found these (sorry, went a little research crazy):

The Use of Animal Models to Study Bacterial Translocation During Acute Pancreatitis (VERY INTERESTING) - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1915599/

Intestinal Microbiota of Dogs and Cats: a Bigger World than We Thought - http://info.theclinics.com/mdconsult/pdf/Veterinary_Clinics_Small_Animal_sample_article.pdf

Small Intestinal Bacterial Overgrowth - http://www.purinavets.eu/PDFs/ResearchReport1999_vol1.pdf

Gut Bacteria and Fiber - http://www.felineconstipation.org/gutbacteriaandfi.html

Prebiotics: The drugless approach to GI health - http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=727328&sk=&date=&pageID=2

Dietary fiber for cats: in vitro fermentation of selected fiber sources by cat fecal inoculum and in vivo utilization of diets containing selected fiber sources and their blends - http://www.journalofanimalscience.org/content/73/8/2329.full.pdf

So anyway...yes, the plan is to continue the metronidazole, prednisolone, and probiotic therapy.  I was considering adding George's aloe vera and SEB to his digestive health regime, as well as Omega-3s. Do you think this will interfere with his "flora"? 

By the way, when I was in The Vitamin Shoppe, I bought the George's aloe vera juice. I came home and did a 2 oz. shot of it. I was expecting it to be sweet or something. It tasted like water! 

 

[ldg]

I opted not to get the one by Renew Life. I don't know if the same concept applies to cats, but I know with my autoimmune disease, immuno-stimulants (which include echinacea) are an absolute no-no.    They can throw immune cells into overdrive and cause inflammation.  I think echinacea may be good for use in cancer in cats, but probably not an inflammatory disorder. I know we don't know what Sebastian has, so that is why I have to consider all things.

I know nothing about echinacea, but yes, it's always important to be mindful of "other stuff." :nod: I don't know the immune-stimulation thing from experience, but from all the reading up on FIV. I know you're right: what's wanted is immune regulation, not stimulation.

I just looked up the FIVtherapy website discussion of probiotics I read (again) not long ago - and as re: bowel inflammation, you may find the discussion (even though geared to FIV) interesting: http://www.fivtherapy.com/fiv_news.htm (Scroll down to March 16, 2012, it's the 2nd news piece posted). The point? Probiotics have an immune-regulating impact.


...And :doh3: I really need to not post health-related stuff when I'm tired. Um... yeah, not all fiber is bad when it comes to dysbiosis.

As some of the articles you shared discuss, soluble fiber is good for helping the probiotics work.

So anyway...yes, the plan is to continue the metronidazole, prednisolone, and probiotic therapy.  I was considering adding George's aloe vera and SEB to his digestive health regime, as well as Omega-3s. Do you think this will interfere with his "flora"? 

By the way, when I was in The Vitamin Shoppe, I bought the George's aloe vera juice. I came home and did a 2 oz. shot of it. I was expecting it to be sweet or something. It tasted like water!  :lol3:

Yes, it is distilled without any of the latex, so not only not bitter, no taste.

I think the slippery elm would be helpful. I would wait until the antibiotics are done to start using it.

 

[ldg]

And thanks for sharing all those great links!

 

[stewball]

I hope sebastian will be ok. An animal doctor in one of my British magazines who advocates less use of the medicines and more homeopathic stuff. He suggests slippery elm for IBS. I tried it for myself. I used to suffer dreadfully from it myself.

 

[goholistic]

Quote:

I just looked up the FIVtherapy website discussion of probiotics I read (again) not long ago - and as re: bowel inflammation, you may find the discussion (even though geared to FIV) interesting: http://www.fivtherapy.com/fiv_news.htm (Scroll down to March 16, 2012, it's the 2nd news piece posted). The point? Probiotics have an immune-regulating impact.

Thanks for this!

I hope sebastian will be ok. An animal doctor in one of my British magazines who advocates less use of the medicines and more homeopathic stuff. He suggests slippery elm for IBS. I tried it for myself. I used to suffer dreadfully from it myself.

Thank you!

 

[carolina]

Hi,
Haven't been here much.... Sorry it took so long to chime in - hope I can help a bit - let's see..... I will address some points with my experience with Bugsy, S. Boulardii and my personal IBD.

The problem, of course, is if he responds well to the pred, if you then take him off the pred, getting him on the novel protein diet is the problem. Because responding well to that would be a good indicator it's IBD, not lymphoma.

It might be in general, but not necessarily - Pred didn't do any good for Bugsy, yet he has IBD, and not Lymphoma. Not all cats with IBD will respond to pred.

If his health continues to decline dramatically, I suppose we can assume that its cancer. 

Well..... Again, IMHO not necessarily - Bugsy's health was from bad to worst for 18 months (his IBD) - what happened was that it took us finding the inflammation trigger and removing it from his diet to solve the issue - while that wasn't done, nothing helped. No treatment, no diet, NOTHING - holistic or conventional. We had to get to the bottom of it- otherwise we were just very slightly managing it.

I left the vet with a prescription for prednisolone and Royal Canin Hypoallergenic Rabbit in both dry and canned. Now I know what we all say about these prescription diets, and the dry in particular is very high in carbs, but we have to start somewhere, right? When I mentioned other brands of novel proteins, such as Hound & Gatos and Addiction, she groaned. I asked her to explain her frustration. She cited the studies (which I've read) that have found traces of beef, chicken, etc. in canned foods. I asked why does this not apply to Royal Canin, and she said she trusts their strict quality control. I had no argument there because I know nothing about RC's quality control. She also wants me to give him 1/4 tab of Pepcid daily (more reason to get those gel caps) and sub-q fluids every other day.

I hope I didn't leave anything out. Thoughts?

My thoughts? Vets know what they are taught in vet school - and as far as nutrition goes, they are taught a few classes funded by the pet food industry, in her case, probably RC. So that's why she reacted this way - it is what she knows.

Patches took them both when he was sick.  It also has an anti-inflammatory effect along with being an antibiotic.  I think for IBD the antibiotic is kind of a safeguard thing.  When the digestive system isn't working right bad bacteria can overpopulate.  The way she explained it to me the anatomy of the cat makes it very easy for an overpopulation of bad bacteria to move into the liver.

I think Flagyl has become the automatic medication for digestive problems with cats.  The vets that I took him to before the one he goes to now always gave him Flagyl even though they didn't really have a clue what was going on with him.

Yes, Flagyl has become quite the protocol for IBD and digestive issues - but it is not really given as an antibiotic in most cases (for IBD) - it is given because of its anti-inflammatory properties on the gut. No one knows why/how it works - but it does. It works better for cats with IBD who show diarrhea as a symptom and colitis, though, as it can cause vomit and appetite issues.

Sebastian continues to eat on his own. He's exhibiting all the classic side effects of prednisolone - ravenous appetite, and more drinking and urinating than usual.

I'm grateful that he his eating on his own and that he's eating the rabbit diet without an issue. But I am also a little bothered by it. How do I know if the pred is working for the inflammation/IBD and actually making him better? I fear that the pred makes me think he is getting better, but that it's all just a side effect of the pred.  Also, he seems to be completely consumed by the ravenous appetite. He won't relax or do some of the things he usually does because, instead, he is following me around the house crying and crying for more food. Will these symptoms subside as his body gets used to the pred? Or do they only go away once pred is reduced or stopped?

Also, Sebastian has developed pudding-like diarrhea. I suppose this is either from the pred, the new diet, or both. So, I have started him back up on the probiotics in the hopes that they'll help firm things up.

I was doing some more research and had to reference Sebastian's labs. For the past two months or so, he's consistently had a high neutrophil count, although it varied in severity. Apparently there is something called Neutrophilic IBD that is more rare. Neutrophilic IBD is when inflammation is actually caused by intestinal bacterial overgrowth (IBO). If this is what Sebastian has, then the pred is not getting to the route of the problem. The more common cases of IBD show increased levels of lymphocytes. His lymphocytes and eosinophils have always been within normal range.

Pred can cause them to become over active - some cats. Other can get sleepy and lethargic.... The way you know that pred is working, is that he seems to be eating well and not throwing up, and has appetite without nausea - those are all signs that the inflammation is reducing.
As far as the diarrhea..... That is weird.

So if Sebastian was your cat, would you give him another round of Flagyl? I'm just looking for your opinion. I value what you guys have to say. 

Right now I'm not going to pursue raw, especially if there's the possibility of Sebastian having an overgrowth of bacteria.

I personally would not do the Flagyl, especially for 3 days, and would do the raw - will talk more about it in the end.

Could it be bacteria that his body is creating on its own, such as "idiopathic" IBO (intestinal bacteria overgrowth)?

Yes, it happened to Bugsy after a course of clavamox, which is why I do not give antibiotics to my cats if I can avoid it if at all possible.
Bugsy has IBD - he was never 100%, completely well, but was managed.... until the day he had an UTI in the middle of the night and had to be rushed to the E-vet.
They gave him a round of Clavamox - that wipped the good bacteria of his gut, and created a bad bacteria imbalance, which combined with his IBD he was not able to fight off no matter WHAT we did. Trust me when I say, we did it all.
We fought a good battle for 18months - there was every medicine, every diet, tests, emergency visits... We were in the vet SO much - yet nothing got rid of his violent diarrhea many times a day.
We had an exploratory surgery scheduled for a week's time when I decided to give RAW as a last shot.
And it worked. Like you on the post above, I was afraid of what the bacteria in the meat would do to him - I was SO wrong!!!
After all this time, here is the conclusion his vet (he is a conventional vet - and my hero, and VERY open minded) and I got to:

The Clavamox wiped out his good bacteria, and allowed the bad bacteria to flourish. Because the food he was eating caused constant inflammation due to his IBD, his gut never healed enough to allow the good bacteria to colonize and fight the bad bacteria on its own - it created a vicious cycle.
Now - we tried ALL the food we could try - so what could it be?
Our conclusion? Food preservatives used in commercial foods - and that my friend, you can only get away from if you feed a home made diet.
Once Bugsy got away from a Commercial diet - problem solved.

As for why I wouldn't do Metro? Because it kills the good bacteria in the flora, and for the true effects to be seen, 3 days is not enough.
IMHO it is an old protocol.
Recently all my cats came up with Clostridium P. - not only that, but it was in toxic levels - it was my fault for buying a suspicious batch of meat - I had a bad feeling about it, and didn't follow my instincts.
Anyways...... Clostridium P., when toxic, can sometimes be deadly in cats - the treatment is metronidazole - 10 days of it.
Well - I found a research about the treatment of Clostridium D. in people, and then I found of Clostridium P in cats! And told my vet that's what I would do instead - S. Boulardii. 30 days, 5 billion CFU, split in 2 doses, am and pm.
Lo and behold, after the first dose, all four had solid poops!
My vet was in disbelief :lol3: until he saw a poop sample a month later and told me there wasn't a reason to do another test for it - waste of money...... And I have 4 healthy cats who didn't need to take antibiotics :nod:
Healthy cats, educated vet, happy, healthy gut floras

Sorry, just going to jump in here. :lol3:

No, he would not necessarily be anemic if it's cancer. That CAN be a symptom, but isn't by definition.

Very simplistically... E. coli, salmonella, etc. are essentially "endemic" to the environment. If he's ever eaten dry food, for example, he's probably been exposed to salmonella. These - along with all of the other problematic strains of bacteria - are actually quite normal in the guts of animals (and people, actually). Normally our immune systems and healthy gut bacteria keep them in check. It is when our immune systems weaken for the million reasons they do, or something about our internal environment changes (which can simply be due to a change in food), that it is possible for the unhealthy bacteria to take over.

You don't need to choose between antibiotics and probiotics. You just need to give them at least 2 hours apart. The antibiotics will keep wiping out the bacterial-based probiotics, but as Denice says, the antibiotic will not kill the yeast-based probiotic (S. boulardii).

In fact, I see probiotics as supportive therapy TO antibiotics. :dk:

The Nexabiotic 20-strain has (basically) the same dose of S. boulardii as the Jarrow with MOS (5 billion CFU). As jcat points out, the advantage of including the MOS is that it improves the "performance" of the S. boulardii in out-competing the unhealthy bacteria. But if pilling is an issue (which it may not be any longer :cross: ), then the Nexabiotic 20-strain mostly likely will at least help, because it's usually palatable just sprinkled on food. The issue with the S. boulardii is that it does not "colonize" the gut in the same way bacteria-based probiotics do, so it is best given 2x a day. If using the Jarrow S. boulardii with MOS, then I would concurrently give an acidophilus probiotic. It just so happens that the Natural Factors acidophilus+bifidus is actually primarly L. rhamnosus, discussed in the article you provided about the role of bacteria in IBD.

And, actually, as the dose of the Jarrow S. boulardii needs to be divided in two, I actually had to use the Natural Factors in order to wind up with a reasonable assurance that the amount of S. boulardii was correct in the empty capsules I had to manually fill. Though... I guess I was using half the adult cat dose, because we were treating kittens. I bought the size 3 caps (via Amazon) and a manual filler from Cap-M-Quick website. http://emptycaps.com/size-3-cap-m-quik-capsule-filler.html Carolina also used this to split the Jarrow+MOS capsules in half, so she could give the correct dose AM and PM.

...and my understanding is that high neutrophils can simply be indicative of infection or inflammation - or even rise due to stress. :dk:

I know you're giving him the prescription food for now. :rub: But wasn't the raw rabbit he liked one of the brands treated with HPP? Because there are a number of sterile raw options now (just as a reminder ).

In all honesty, if I was treating my cats again - TREATING - not maintaining - I would go with Jarrow.
Trust me - the cats will NOT eat it on their own It tastes awful, like bitter beer :nod:
BUT - it is amazing stuff........... I would do what Laurie did - buy Gel capsules and divide the capsules in 2 - give 1/2 dose in the am, and 1/2 in the pm.
I gave them by hiding it in the meat - I feed meat chunks, so I would cut the meat into butterfly cuts, sprinkle the probiotic inside, close it carefully, cut it into smaller pieces and serve

Exactly. :nod: And according to that piece you posted, some cats have a genetic ummm.... disposition? proclivity? well, genes that contribute to the problem.

Yes, the metro is often just a 3 day course. :dk: I use it on the ferals when it's apparent they've got diarrhea (I assume giardia. Does seem to clear it up, though sometimes we go 5 days. I just keep it on hand).

I like the plan.

As to the best probiotic to use... with IBD, I think it's really hit-or-miss. That's why there are some studies indicating XYZ probiotic helps; others where it doesn't. So is it better to hit it with a broad spectrum of probiotics of lower potency... or try higher levels with less spectrum? I really don't know. I think you give something a month, and if it's not helping, try something else.

FYI, the main reason I use the Nexabiotic is for S. boulardii in a palatable format. I'm not treating anything, so I want to be able to just sprinkle it on food and have them eat it. I don't like that it has so little of the rest of the strains. That's why I still use half the dose I was of the Natural Factors acidophilus+bifidus. Also, because I'm using it as a supplement, I use 1/2 of the dose of the Nexabiotic (I keep tweaking :lol3: ) vs what's recommended for treating various bad bacteria (the recommended amount for a cat is 5 billion CFU of S. boulardii. I now split one 5 billion CFU capsule between 4 cats, 2x a day, giving them 2.5 billion CFU of S. boulardii total daily).

As to the Ultimate Flora Advanced Immunity... I don't understand the label. I don't understand what's in it apart from the 10 billion CFU of S. boulardii? :dk: As I said, we do know that the effective dose in adult cats for treating at least C. perf, C. diff and Coccidia is 5 billion CFU - at least when combined with the MOS. That was the amount used in the C. perf study in cats, and the amount Carolina used that resolved the overgrowth in her kitties. I used a half dose for the kittens, and that resolved their coccidia. The kittens were only kept on it for a month (the amount of time in the published study); Carolina continues her cats on a half dose daily (split into two doses) as a preventative.

Ok, here's the link to the Ultimate Flora Advanced Immunity product on the manufacturer website: http://www.renewlife.com/advanced-immunity-probiotic-supplement.html#specs It's Renew Life! :doh3: I do know this is high quality manufacturer. :nod:

Yes - it's got the MOS. Good! I know echinacea is used in cats. As to the "Saccharomyces cerevisiae" derivatives, S. cerevisiae is brewer's yeast, which we know is safe for cats. And with 10 billion CFU, you can give 1/4 capsule 2x a day for a total of 5 billion CFU. :nod:

The fiber: I don't have a reference piece handy. I'm sure it exists though, because ANY diet recommended for people with dysbiosis and related leaky gut syndrome, candida overgrowth, etc. are ALL high protein, NO carb diets. There are candida diets where starches are slowly re-introduced. But with dysbiosis & leaky gut, the GAPS diet is very strict about no starches, no carbs. (And works well for our kitties. :lol3: ). Both recommend high doses of probiotics for a fairly long term. The goal is providing no substrate for the bad bacteria; keep replenishing the healthy bacteria, and just crowd out the bad stuff without giving it the opportunity to regrow - until the body heals enough (in people, the GAPS diet says it can take up to 18 months) to regulate with "normal" doses of probiotic supplement.

:dk: Just putting that out there.

...and I forgot it was the dog version. Yeah, that could be a problem, especially given the veggies, thus fiber content. ...IF the problem is IBD due to dysbiosis, and potentially leaky gut on top of it.

Of course, with the use of probiotics, it really isn't much of a health risk to try and see if it helps.

I already addressed most of this.... Aside from a couple of things - for giardia, per my vet, the dose was 5-10 days, 10 days to be on the safe side, of Metro. Not sure if they do the bare minimum for Ferals, since they are harder to come around to pill :dk:

As for the Probiotics - I personally have IBD - I have personally taken MANY probiotics - and I can personally testify that nothing, nothing has worked for me as S. Boulardii. I was taking Align before...... Now I take Jarrow S. Boulardii - 1 capsule in the am, and 1 in the pm - it is a life saver :nod:
My cats are on a maintenance dose of 1/2 capsule of Nexabiotic in the am and 1/2 in the pm meal because it is palatable, and they will be for life :nod:

I know nothing about echinacea, but yes, it's always important to be mindful of "other stuff." :nod: I don't know the immune-stimulation thing from experience, but from all the reading up on FIV. I know you're right: what's wanted is immune regulation, not stimulation.

I just looked up the FIVtherapy website discussion of probiotics I read (again) not long ago - and as re: bowel inflammation, you may find the discussion (even though geared to FIV) interesting: http://www.fivtherapy.com/fiv_news.htm (Scroll down to March 16, 2012, it's the 2nd news piece posted). The point? Probiotics have an immune-regulating impact.


...And :doh3: I really need to not post health-related stuff when I'm tired. Um... yeah, not all fiber is bad when it comes to dysbiosis.

As some of the articles you shared discuss, soluble fiber is good for helping the probiotics work.
Yes, it is distilled without any of the latex, so not only not bitter, no taste.

I think the slippery elm would be helpful. I would wait until the antibiotics are done to start using it.

The only thing that I know to be good for immune systems - and Lucas, Tammy's cat is using very successfully, so has Bugsy is Transfer Factors - it is not a booster, it is a modulator, which is why it is so great. If you do get it, get the CLASSIC, not the Plus

Hope this helps a little......

 

[goholistic]

Carolina, thanks so much for chiming in! I know you've been busy, so I really appreciate the time you took to respond so thoroughly. 

  As always, I appreciate your blunt honesty.

Regarding the Pred...since being on it, Sebastian has been eating VERY enthusiastically, not vomiting, grooming again (this is typically his happy activity), and sleeping in bed with me.  

  When he's not well, he'll go somewhere alone. He hasn't vomited at all (not even a hairball) in about 5 days, which is the longest it's been since his first episode back in July. He's been on the Pred since last Friday morning (9/13). The diarrhea is probably from the diet change. I did switch him over to the new novel protein diet cold turkey...no gradual transition...my fault. He poo-ed tonight and it is starting to firm up. Other than the diarrhea he's had for the past several days, Sebastian hardly ever had diarrhea. It has typically been vomiting (including lots of hairballs), anorexia, and extreme fussiness with his food (turning his nose up at everything, hence, nausea?).

Your story about Bugsy tanking after given Clavamox makes a lot of sense. Sebastian hasn't been right since he had his dental on July 2. I truly think that experience, and all the medications that came with it, is what set him off.

I want to start him on the S. Boulardii, but I'm hesitant to shove two more gel caps down his throat right now. He's tolerating what I'm giving him in the AM and PM, and I "award" him with a meal afterwards since that's all he really wants.

  I mean, if it's crucial, I'll do it. But if I can try the Nexabiotic since it is more palatable that'll at least get him started on it.

If I'm going to try raw, I'd prefer to go commercial raw to reduce the stress for me, but I don't know how he'll fare with all the added fruits and vegetables (Nature's Variety and Primal, for example).

I'll check out Transfer Factors.

 

[carolina]

:lol3: Someone has to appreciate my blunt honesty -
In all honesty - I am in a hotel and my connection stinks - I wanted to make sure to address all I could before I lost connection...... That's why I might been kind of blunt - I was just typing fast :nod:

As for the diet with veggies - FWIW, Bugsy started on Nature's Variety - it has veggies - but keep in mind, it is less than 5%.
It took me 8 days to transition him - you really should check out my transition thread..... it is LOOOOONG - but it might be worth it for you :nod:
On the first day he ate 100% raw, his issues were gone - G-O-N-E. Solid poop for the first time in his life, and we never looked back.
He has been medication free ever since.
I have no doubt raw saved his life!

After Nature's Variety I transitioned slowly to Rad Cat, then Hare Today, then Home Made...... But He did just fine on NV.

The key with these guys is to do it SLOWLY - I introe'd him one TSP at a time, mixed into his wet food. Every day I would mix one more TSP, and take a TSP of wet off, depending on how he did.
And for every flavor I introe'd, I did slowly too - just like you introduce kibbles - I introduced each meat :nod:

As for the probiotics - no harm in trying Nexabiotics - if it doesn't work, you can always move to jarrows.... I would give 1 full capsule in the am and 1 in the pm - don't worry, they are small, and palatable, and you can mix them with the food :nod:

I am lucky - my vet is not a holistic vet, but he is VERY open minded. He is a Texas A & M vet, and does a lot of research with his T A&M peers. So he is not really closed to any ideas - when I bring things up to him, we will discuss it, he will research, discuss it with his peers and get back to me - we will give it a try. We are partners - there is no black and white, unless there are things that are NOT safe - then he will tell me NO.
But we even treated Bugsy with herbs from the Amazon after he did his homework (I am Brazilian) - did I say we tried it all? :lol3:
One thing though - ALWAYS, ALWAYS discuss with your vet what you are doing - let them know everything you are doing, they need to know.
If you don't agree with a protocol, whatever, fine - but tell/discuss with your vet every step - she needs to know - it is a partnership..... And the great thing about it, is that you end up educating her too.
My vet has learned SO much about Bugsy - he now recommends raw to his IBD patients who didn't have a solution before harsh drugs..... He learned about egg lecithin for hairballs.... Learned about curing Clostridium with S. Boulardii...... It's a cool thing - stand your ground, and create a partnership with the vet - the three of you will gain!

 

[denice]

I think this reinforces that there is no one size fits all solution to this.   Even though Patches had the vomiting and constipation the flagyl would work for him.  It would bring him out of a flare and I would try the different foods and he would be back to the vets with a flare again and another round of flagyl which would bring him out of it again.  I never tried raw but I would have him on a protein for several months and think I had found the solution and he would be sick again.  The only thing that has kept the problem in check for him is the low dose of a steroid.

Unfortunately I think there is simply no one right answer.  For Patches I really don't think it is a food intolerance.  I went through the different proteins for six years with him still having flares.  Hopefully Sebastian's can be controlled with a diet/probiotic mix.  That is certainly a much better solution than the steroid and the possible side effects from long term use.

 

[goholistic]

I do not want to turn this into a raw discussion, but...I'm going to see if I can find Primal locally. I would want to start with rabbit, and I like that Primal's rabbit is just rabbit. NV adds pork stuff. I should probably do this while he's eating well. Carolina, you DO sound like an informercial spokesperson for raw. 

  For good reason. 

Okay, the problem with the vet...I'm not really sure just how open-minded they are. I think they feel negatively towards raw. They know what I'm giving Sebastian up to this point, so nothing is secret, but the doc just might freak if I say I want to start him on raw.  I suppose this is where the holistic vet would come in; I do know they support raw.

And yes, just like people, I think animals respond differently to different treatments. So we'll just have to see I guess. The plan is to slowly taper Sebastian off the pred and see what happens.

 

[denice]

My vet is against raw.  I think that is common for conventional vets.  She does believe in the benefits of wet over dry, many conventional vets don't.  There are still some conventional vets that believe that dry is superior to wet.

 

[carolina]

Denice, you are absolutely right! Each cat is an individual, and with IBD not one thing will fit all.... Unfortunately it is a pesty little disease, with a long road of trial and error!
Goholistic, yep, I am A big proponent of raw, many reasons for it; but when it comes to inflammation, it just takes away everything from the diet that could possibly be causing an issue, and that can not be done with any other diet. It is as good as it gets for those guys, which is why many ibd kitties can go off meds once on it.
As for the vet, that's common.... But then they see the results :nod:
Bottom line is, you are your kitties advocate, and you and your vet work together to figure out a plan. I don't blindly do everything my vet tells me to do, I usually get in with a well researched plan to discuss, and we go from there. It works well. I had a vet in the past who only followed protocol - if I continued going to him and following his lead, I have no doubt Bugsy would be dead, and I would be broke. Stick to your guns, Instincts, and work together.