? Yum and intermittent diarrhea and what is going on?

@Marje and Gracie
@Wendy&Neko
Yum has had intermittent diarrhea since 9/3.
She had blood work indicating kidney disease on 8/14. (Blood work is on labs tab.)
I put her on phosphorus binders and added RadCat raw lamb (and once raw beef) to her diet mid August.
She started having intermittent diarrhea (about 15 out of 37 days now) on 9/3.
At first her appetite was not affected and she maintained her weight.
She had more severe diarrhea on 9/11 with inappetence.
Her required insulin dose started dropping and has continued to drop since then.
Her appetite recovered after a day or 2 and the diarrhea became intermittent again.
On 9/19 we rechecked her kidney numbers---with in-house lab work, not the usual lab.
Her phosphorus level was improved but not enough, her creatine level was much better.
I encouraged Yum to eat more RadCat lamb and I reduced her Fancy Feast by half. I was only adding phosphorus binders to her Fancy Feast, so her daily phosphorus binder dose decreased slightly (from 300 to maybe 200).
We rechecked her blood work on Friday 10/6, with the usual send-out lab. It was awful. Her phosphorus number had skyrocketed and her creatinine number was up. I will note: she did vomit twice (coincidentally) a few hours before her blood work. She vomited food once (which she re-ate) and a large amount of water once. She never vomits food. Could the vomiting have influenced the blood work result?
Since the vet visit on Friday, she vomited water on Saturday morning 10/7 and the diarrhea and inappetence have returned to stay.
I began dosing her with metronidazole (50 mg every 12 hours) on Sunday morning.
She had a 2/3 normal/1/3 diarrhea bowel movement yesterday but all diarrhea again this morning.
She might have eaten 100 kcal yesterday max. She's not eating much today but it is early yet.

Her water consumption has dropped a bit along with her insulin dose.
It was 8 oz or more a day and now it's more like 6 oz.
You'd think the kidney disease would make her thirsty. Diarrhea should make her thirsty too.

Her activity level is normal but her weight has dropped 6 oz since Friday.

Should I stop the RadCat lamb in case it is causing the diarrhea? I had hoped to go through the 7 days of metrodinazole first before resorting to a food change. The onset of the diarrhea trailed the food introduction by several weeks. The RadCat is the only low phosphorus/low carb food she will eat. Of course I can increase her carbs with kidney prescription food and just give up on remission. I think my vet thinks I should do that.

What are causes of intermittent diarrhea? It's not usually indicative of kidney disease, according to my vet. Yum hasn't vomited since Saturday.

Is it suspicious her insulin requirements are dropping with these other issues (from 3+ units to 1.25 units)? Well, for the past few days she is eating less and losing weight, so that could make sense. But it began dropping on 9/11, with her first brief bout with inappettance.

Any ideas or suggestions are welcome. She is still a very happy cat. I am very worried.

 

Has the vet mentioned anything about trying her on a probiotic? It might help with the diarrhea. I work as a vet tech, and have seen kitties just get diarrhea from the stress of all the other ailments affecting their bodies (i.e. FD and CKD). You might want to consult your vet about the addition of a probiotic to help soothe that GI tract.

 

We haven't discussed that yet. I have put Fortiflora on her food to stimulate her appetite. I have had another cat on a probiotic off and on for other reasons. I might have tried one on Yum after the first bout of diarrhea. I will try again. I guess I should wait until we finish the metronidazole treatment. Thanks for the suggestion.

 

I have mine on FortiFlora anyway (although he did have a bit of soft stool/diarrhea when switching from dry to canned food), but he LOVES it. It might help with her appetite too...check with your vet, and see if he thinks it might be a helpful addition. Sometimes we prescribe Probiotics and Metronidazole together.

 

I obviously can't give you medical advice, but I had a similar thing happen with Asia and it was resolved. Mind you, this was before she was diabetic, but she was CRF at the time. She had a UTI which they treated with Convenia and all seemed well until the 2 week mark, then she started eating and drinking a lot loss, sitting in front of the water bowl looking sad. I went out and bought her "junk food" nothing too terrible, but BFF and gravy kind of canned food just to get her to eat *anything* because she was losing weight. She then started vomiting a time or two per day and had diarrhea. At first the vet started throwing prescriptions at her to treat each symptom: mirtazepine for vomiting, metronidazole for diarrhea, fortiflora for her GI (she wouldn't eat it though). It seemed to exacerbate her symptoms and the vet decided let's take her off all the meds and see what happens, that helped. She then gave me a B12 shot to give her GI tract a boost and I gave her one shot of that a week for 4 weeks. Whatever it was got better and the B12 seemed more helpful than anything else.

Our consensus on what probably happened is whatever the initial problem was, we don't know, but her not eating and then being given foods that she doesn't normally eat upset her stomach. The diarrhea was never figured out, but can sometimes be a side effect of the antibiotics.

Since Yum had a recent diet change, that could be upsetting to her GI tract (even if it's better for her in the long run, changes like that can make them wonky). Especially if you're switching not just between two different proteins, but two entirely different brands, perhaps one has an ingredient she has an intolerance to? Maybe try just feeding one brand and not the other for a few days to rule that out by elimination? I think probiotics are a good suggestion, it can't hurt anyway. Maybe ask your vet if they think a B12 shot would be useful?

 

I think I read about B12 and crf, or some other issue, recently. I will bring that up with my vet. Thanks.

 

All things crf/ckd

http://www.felinecrf.org/index.htm

 

There are other options to Fortiflora that might be better. http://www.ibdkitties.net/supplements/probiotics/
Take a look at the section on S. boulardii.

I would try the Texax GI panel, possibly an ultrasound too. The dropping insulin requirements combined with weight loss has me thinking more investigation is needed. The GI panel will tell you if you need to supplement the B12. Too bad you didn't get the T4 test done this time. Weight loss can be a sign of hyperT.

I would try to stick with one protein (type of meat) for now. Then if her diarrhea goes away, then lamb might be the culprit. Once she's stable on one protein, add a second one slowly.

Good luck.

 

Thanks. She had an ultrasound in the spring and all looked well. I did stop the lamb yesterday afternoon. She ate her 94 kcal can of Fancy Feast last night, so we are out of ER mode at least for today, at least so far. I am pretty sure her weight loss is due to not eating.

 

Great link! Thanks!