Cat with uncureable, chronic diarrhea

Hi everyone, I'm new here and desperate for some insight into this horrible problem with my cat.

Eddy has had chronic diarrhea for a long time now. Light brown and very soft semi-formed stool, or completely liquid. And the smell is off the charts awful and can fill the house.

He has had the works done, vet-wise. Injections, supplements, different dry and wet food, prescription dry food, extensive and expensive bloodwork tests, stool samples tested, etc. The only thing that ever came back problematic was non-existent cobalamin. That was boosted back to normal with a series of b12 injections, and did not impact the diarrhea. What the vet is recommending next is a exploratory surgery with biopsies to check for things like IBD. It's estimated at $800-$1000. Absolutely not. an. option. So what next? The only thing I can foresee is spending more and more money on different food and supplements, and that just stresses me out. We have been doing that for so long and nothing changes with this cat. I do realize that it's unavoidable to spend some money on different treatment options, but I'm cranky about it. If anyone here could please help give me insight into what is going on here, and some good practical advice, I would be so grateful! Thank you.

 

Ask your vet about empiricle treatment (treating "as if" that is the condition) for exocrine pancreatic insufficiency. If the enzyme producing cells of the pancrease are damaged, you get malodorous, light colored, voluminous feces.
The treatment is adding digestive enzymes to the food, preferably the Rx ones for optimal effect.
This would be much less expensive than invasive testing; ask the vet what possible harms could happen.

 

He was tested for that and the test came back negative, which confounds the vet since his symptoms most match with that particular condition. I actually thought of asking for the enzymes, so I'm glad to hear someone else suggest this! Thanks! I will definitely ask.

 

Have you tried a raw or freeze dried raw diet? Grain free & novel protein source helps my cat with chronic diarrhea. He does best on Felines pride raw rabbit. Good luck, I can empathize!

 

I feel for you. And Eddy. Saoirse had bad - and protracted - diarrhoea during a pancreatitis flare a few months back. It was tough on both of us. I feared she'd never have a solid stool again.

The B12 deficiency is indicative of malabsorption issues. Has your vet ever prescribed Flagyl (metronidazole - an antibiotic) or Stomorgyl (contains antibiotics metronidazole and spiramycin and apparently is not as foul-tasting as Flagyl, according to my vets)? Saoirse was prescribed Stomorgyl and it helped with her diarrhoea. Also, I've seen many members here post about treating diarrhoea successfully with Flagyl. Another prescription that helped Saoirse was Pro-Kolin. It's a kaolin paste plus probiotic - helps to make the poops more solid and replaces beneficial gut flora.

I found that Saoirse did better on bland, more easily digestible foods. Initially all I could do was feed her tiny amounts of poached chicken breast plus a 50-50 mix of poaching broth and water to keep her fluids up (about 8g/hour + 24 ml fluid - timed feeders were an absolute necessity and a godsend). I then moved her onto a liquid recovery diet called Liquivite before finally finding a bland solid food she could tolerate. It did take time and any diet changes I made were extremely gradual.

BJ's recommendation about getting "as if" treatment is a good one. IBD can be helped with steroids (I've seen posts here but can't remember the names of Rx's members have had success with - hopefully other members will be able to advise on which meds help.) Is Eddy diabetic? If yes, then treatment with a steroid may require an increase in insulin dosage. If not, then it's important to be aware that steroid treatment may induce diabetes.

 

If you end up looking into supplements, try slippery elm. It coats things and increases mucous. It may help lessen the irritation.

 

Was Eddy ever treated for Giardia? That sure sounds like the symptoms. Treatment is usually Metronidazole (Flagyl) or that plus Panacur if the diarrhea is persistent.

We have treated quite a few tummy problems with Flagyl. It is NASTY, but has always worked on clearing it up quickly.

 

Here's the thing about lab tests - they aren't perfect, they're just what is available.

It is possible to have a false negative, where the condition is present and the test does not detect it.
It is also possible to have a false positive, where the condition is not present, yet the test indicates it is.

Reference ranges are created by testing both those believed to have the condition using some other detection method and those who appear not to have the condition. The numbers obtained from these 2 groups typically have some overlap. That overlap area is often split into above and below this number is positive and negative ... but that may not be true. Hence the suggestion to treat as if exocrine pancreatic insufficiency was the issue.

False negatives can happen with some of the intestinal parasites such as giardia, coccidia, camplyobacter, and more, all of which can cause diarrhea and foul-smelling stool. If the parasite isn't shedding, it doesn't show up in the fecal tests where you visually inspect for the organisms.

 

One of my civies, Libby, had IBD. We did not do the exploratory surgery to confirm that, but did try dietary changes. The vet recommended prescription diets (Hill's ZD) made the diarrhea worse. It was so bad, I had to shut her up at night in a separate hallway bathroom with 3 litter boxes and was cleaning up multiple poo spots on the floor every morning as well as cleaning up 3 litter boxes.

Vets regularly try to prescribe a "novel protein" diet. Well that did help my civvie some but I took a look at what was in that food and what was in the other vet prescription food (Hill's ZD hydrolized) and tried a process of elimination diet. Come to find out it was the rice in the ZD food that was causing the diarrhea. She could not tolerate any rice or any other grain in her food. Fish would also cause diarrhea issues so I carefully read food labels to make sure fish was not an ingredient in her diet.

I tried to get her to eat raw, but she wouldn't have anything to do with that. Perhaps you will have better luck with your cat.

I know you have talked about trying many different foods, but we don't know of everything you have tried. Perhaps more information on the different foods you have tried unsuccessfully would be helpful to provide to us.

 

KT had that nasty poo too - took us forever to 'fix' it....his was EPI. When he started that poop, I'd give him pro-pectalin for a couple of days and digestive enzymes for several more days. It helped him, don't know if it will help sweet Eddy.

 

Noodle had symptoms exactly like the ones you describe and had every test in the book. He also tried diet after diet (vet-prescribed). No improvement. In fact, he got worse than ever on the so-called hypoallergenic and hydrolyzed protein diets (Hills Z-D, etc.) Finally, out of desperation, I was unloading all this long history on a new vet. He asked me if Noodle had ever been tested for food allergies. I told him that in the whole 4 YEARS of this struggle and several vets, NOT ONE had ever told me there was such a thing. So they took blood, sent it off to Spectrum Labs (it cost $140) and it came back that Noodle was highly allergic to TUNA, SALMON (in many, many canned cat foods), rabbit (in the so-called novel protein diets), soy (in Z-D), corn (in the Royal Canin he had been living on--again, vet-prescribed), tomato (in some canned cat food--why, I don't know) wheat, brewers rice (the lead ingredient in many dry formulas) and brewers yeast. Quite a list! So I took my magnifying glass to the canned aisle of the pet food stores and bought safe trial formulas that did not have any of those ingredients. Noodle was also a newly-diagnosed diabetic so I had to also factor in the high-protein, low carb foods. Well, it was like someone threw a switch. After we eliminated those ingredients he had firm, non-smelly stools for the first time since we adopted him 5 years ago. He had had a biopsy a month before showing mild-moderate IBD and due to the findings, the pathologist strongly suspected allergies. It turned out to be true. The only diarrhea Noodle has had since was when he was given antibiotics for a UTI and then, recently, for his dental. I'm sorry, I know this is a LONG post and many vets/people scoff at food allergy testing. But all I can tell you is it was an absolute miracle for Noodle and I wish I had done it years before. The hundreds of dollars I spent on tests and vet-prescribed crap food I would love to have back I hope you find the right solution for poor Eddy. Believe me, I feel your pain. I know how disheartening and hopeless it seems when you do everything you are told and it doesn't make any difference. Please keep us posted.

Christi

 

Thanks for the info on Noodle's experience, Christi. I know that Saoirse definitely has an issue with salmon oil. Thinking back, I remember offering my little furry family some salmon as a treat one Christmas. Saoirse loves tuna so I thought she'd go bananas for the salmon but she wouldn't touch it then either. I can't feed her Granatapet foods because the salmon oil makes her nauseated. :-(

I also note that you fed Noodle Royal Canin food. I strongly suspect that Saoirse's initial problem was IBD with pancreatitis and diabetes as sequelae and she was on RC foods, too. Her tummy was getting progressively balder but her vets at the time put it down to stress/age. Since stopping the RC foods and switching to a species-appropriate wet diet (basically meat, vitamin & mineral supplements and a small bit of soluble fibre) all of her tummy fur has grown back. I'd like to get help for her IBD because her tum still gets distended at times, but I'm very reluctant to go the intestinal biopsy route. I'm really grateful for the info you've provided here about non-invasive allergy testing. I'm going to ask our vet about getting Saoirse tested at her next check-up. (I want to get another Spec fPL test done anyway, so she'll be having a blood sample drawn anyway. Do kitties have to fast before the allergy tests?

 

Hi Aine,
No, Noodle didn't have to fast before the blood test. In fact, when we took him in it was for the weight loss and diabetic symptoms and the discussion on the IBD/food allergy suspicion came up incidentally. Lucky thing for us and Noodle that it did. I hope your vet is open to at least trying this option for Saoirse. It would be wonderful if some simple changes like Noodle had would make a big difference for her too. Please keep us posted and give a loving pat to your baby girl

Christi

 

Emme had lots of those symptoms. We tried unique protein diets and it didn't make a difference. Finally, after 4 fecal exams she tested positive for Giardia. Treatment with Flagyl and the diarrhea was gone.

The possibility of allergies also sounds like a good avenue to explore.

 

Thanks for the additional info, Christi. I've passed on the fusses to Saoirse. Be sure to give Noodle some scritches from me, too.

 

Everyone, thank you for the kind and helpful responses! I don't recall everything he's been tested for, but I know there were many tests. The vet has mentioned before that he doesn't totally fit the symptoms of a diabetic, and I agree. He also has been repeatedly tested for parasites, but from what I see here that may be worth revisiting. He hasn't been too excited about testing for allergies either, but when I report back on how it's going with the Pancrezyme, I'll try to arrange it if this stuff doesn't work. And speaking of Pancrezyme, I gave his first dose earlier tonight. I'm not excited about this stuff and I would rather it come down to food allergies or something easier and cheaper to treat (buy a certain type of food? Okay!). In the meantime, I've added raw food to his daily diet, and I can see a small improvement, so nothing major. He's also on his second monthly dose of steroids (via injection), which doesn't seem to help. If the Pancrezyme doesn't pan out, another option suggested by the vet is Chlorambucil. Anyone have any experience with that? Again, my thanks to you all for helping!

 

I'm glad to read that Eddy's showing a little bit of improvement.

As a general observation based on my experience with Saoirse, any changes I made were gradual - too fast and it tended to upset things again. Even when I found food that agreed with her better, she went through a slow succession of tiny improvements before getting to where she is now, but the overall improvement is very significant. It's wonderful to see her looking to be fed again, enjoying her meals and producing solid poops! Look for and celebrate the 'mini victories' - they really help maintain one's sanity along the way to recovery! Keeping a daily secondary monitoring journal helps, too, not least of all because it can be extremely helpful to refer back to what did or didn't work at various stages in treatment.

 

Update: Hard to tell how Eddy's feeling on the enzyme, but he seems quieter and less active. Not sure if that's a good or bad thing. As for his stool, it actually, finally, looks about normal! I don't recall the last time I've seen it look that way. The smell is better, too, but not quite what I could call normal, compared to my other cat's stool which is completely normal. I don't know if that will continue to improve. He actually seems to need this stuff, which in some way still surprises me given the negative result of the pancreatic insufficiency test. But now it really seems apparent that the result was a false negative. Anyway - I hope it's not too soon to be making these conclusions. It really seems to be what he needs, though. When it comes to him eating his wet food mixed with the powder, he's hesitant and but will eat some or most. Does anyone have any suggestions of how else to administer it? Pilling this cat is not an option. Thanks!

 

That's great news! And a big relief to you, I imagine.

I just went to dig up a link for you to the only site I found that had a fair bit of info and research links for feline EPI. It seems they've set up a new website for cats with EPI and a forum. I've not reviewed the EPI in Cats site or forum yet, so can't comment as to the quality of info there, but there are some useful research links on the first site.

EPI in Cats Info - Articles and Research Links

EPI in Cats - new website

EPI in Cats - Forum

 

Critter Mom - thank you, thank you! I have been reading them.

To everyone, another update: Eddy is continuing to do well with his stool but is not yet putting on noticeable weight (I'm now giving him large portions). Since taking away dry food, he has become a complete @$$#*!3. He is not adjusting well to not being able to snack on demand. And I can't leave it out because my other cat will eat it, and she's already overweight. He is constantly frantic for food and we have to put him another room when we eat to avoid him climbing on us, getting into our food. He is also a non-stop counter surfer. Little deters him. Him and my other cat are fighting a lot more, he's getting into her wet food if I don't police every second of meal times - that I know could be avoided if I feed them in separate rooms, which I think I'll start doing. Anyway... His behavior is wearing my husband and I down emotionally - the fighting, the constant getting into food, getting on the counter, getting into groceries just brought in, the constant nagging, the constant hyperactivity from him. He doesn't even sleep as much. I know he's acting so wound up because the other cat goes after him a lot and the lack of on-demand snacking. *sigh* So, my question: what kind of dry food can I feed an EPI cat without having to add pancreatic enzyme each and every time? I cannot realistically stick to a routine like that, of having to put enzyme powder on every serving of dry.

Please, help... Eddy could easily be featured on My Cat From Hell. We are both unable to handle much more of this. We feel like we're at the point where it is time to find him a new home.

EDIT: Eddy has also begun biting on to various fabric surfaces and trying to tear them (recliner, blanket, carpet)... What on earth??

 

Ask the vet if the enzymes would be harmful to the other cat.
Would timed feeders such as the Pet Safe 5 be helpful to dole out the food to both cats in separate locations help?

 

To clarify, is Eddy diabetic as well as having EPI? The craving for food like that sounds like how a cat with polyphagia behaves (excessive, ravenous hunger).

As for the biting etc., is it possible this might be due to anxiety?

If he were mine I'd be looking to take him to the vet.

 

Hey everyone, another update. First off, no, Eddy is not diabetic. So far, just EPI. I asked the vet for a prescription dry food, and we gave him some Purina EN without adding pancreatic enzyme. He soon vomited and had diarrhea. :-( So, he definitely cannot eat anything without the enzyme powder, even if it's food with very digestible ingredients.

Things have not been good with this cat. He is absolutely frantic for food between meals. He is always on the counter, he is always getting into our food, he is always hyper, he is always whining. Owning this cat is truly no longer rewarding or enjoyable. It's just emotionally draining maintenance with nearly no benefit. The vet said he he has done all he can do diagnostically, so our options are slim.

 

Feeding frequent small meals may help with the frantic hunger until he is able to stabilize.

 

If you need small, frequent meals maybe getting a timed feeder would help your sanity.

 

I can't recommend timed feeders highly enough. Saoirse needs to be fed mini meals every 2 hours.

 

Perhaps a slimcat food dispenser to slow his food intake and wear off a bit of energy? http://www.amazon.com/gp/product/B0018CG40O/ref=oh_aui_detailpage_o04_s00?ie=UTF8&psc=1 . Although, that might be difficult with the enzyme powder needed. Rescue Remedy to try to calm him down (the pet version uses glycerin as a preservative instead of Brandy in the regular version. In either case it's a negligible amount, so go with either version.)

 

I know I am late coming to the conversation, but wanted to ask if your vet has checked for tritrichomonas foetus? It is a surprisingly rampant feline protozoa that doesn't show up on typical tests, and many vets don't seem to know about it.

We adopted a rescue cat and within a few days he was having terrible diarrhea. At first we thought it was a food sensitivity until we discovered that he had actually been adopted and returned to the rescue a number of times for escalating bowel problems. He was misdiagnosed with giardia and another parasite, then we looked and IBD and allergies, but nothing was working. Finally, I heard of t. foetus and the symptoms fit him exactly. Like your cat, he acted like he was starving all the time, along with that horrible, HORRID-smelling loose stool that seemed to come and go. Pro-pectalin and Forti-Flora seemed to help with symptoms, but they always came back. We were truly at wit's end.

He and his two siblings - one at the shelter and one adopted to another home - were all diagnosed with t. foetus. Within a week on the right medication, he has been symptom free ever since. In fact, he grew about four inches taller and longer once he was well because he was finally getting the nutrition he needed from his food!

 

I just want to say thank you to all of you for your kind and helpful responses, for staying with this thread as I asked lots of questions and posted updates.

We had our beloved Eddy put down last night. My husband and I are heartbroken and grieving. This will be very difficult for a while. We had done so much for him with little improvement. We miss our buddy. Thank you again to each of you for your help and suggestions.

 

sending purrs and prayers at this difficult time.

 

I'm so sorry to hear it was Eddy's time to go.

 

I'm so sorry for your loss.

 

Requiem aeternum, Eddy.

{{hugs}}

 

Im so sorry for you both!

 

Lighting a ring of candles, in memory of your beloved Eddy.

 

I'm so sorry for your loss -Fly Free Sweet Little Eddy and land softly!

 

I am so very sorry you had to say goodbye to your beloved Eddy. There is nothing harder and I pray your heartbreak will lessen with every day. Thinking of you...

Christi