Thank you again,
Now I have to say Lypex is an enzyme product that we usually used for pancreatic insufficiency in dogs, something we really don't see in cats (and hence why it didn't spring to my mind when you noted it). Still, it has been reported to help in cases of feline inflammatory bowel disease. Therefore, if he is responding to that, I wouldn't be thinking pancreas necessarily (especially if no testing was done) but questioning the state of his gut.
In any case, for him to have diarrhea for this length of time that recurs when you reduce his treatment dose suggests that we have an ongoing problem that the treatment is only managing and not curing. Therefore, we'd really want to be looking deeper into this for Tigger. Especially since we can see chronic diarrhea in older cats related to low grade chronic bacterial infections, viruses, parasites (worms but also protozoa), GI sensitivities, inflammatory diseases of the GI (ie IBD), and cancer (GI lymphoma). Furthermore, we can sometimes see chronic GI issues be secondary to metabolic diseases (ie diabetes, thyroid disease) or organ issues (ie kidney, liver, etc).
In this case, with his lack of full recovery with the Lypex, it'd be ideal to start taking some steps to narrow down the causes for his signs and pinpoint the trigger. To start, the first step would be to rule out worms. And while worms may be a lesser risk for an older cat, it is sensible to treat for them if you haven't since this started. This is because treating to make sure they aren't our causative agent is an economical means of making sure we don't miss them as our cause before looking into those other differentials. In regards ***** ***** there are a lot of OTC options but I would note that Panacur may be ideal here since it will rule out some of our protozoa as well.
Otherwise, if we have chronic diarrhea in a cat, we will often test a fecal sample at this point. This is sent to the lab and can tell us if there are any infectious agents present. This would also be a means of ruling out worms and protozoa. As well, the feces can be cultured to tell us what bacteria may be present and what antibiotics would work best to clear them. And if there was a concern about a particular virus, this too could be detected in the feces. Depending on the findings of the fecal analysis, we will know if an infectious process is present and thus what to be treating for.
Though if that comes back all clear, then our next step would very much depend on the vet's initial exam findings. If there are concerns about primary metabolic or organ issues, then bloods could diagnose that. If that was found to be the source of our troubles, often addressing them +/- antibiotics clears the diarrhea.
Still if the exam didn't suggest that, his GI felt thickened, and because they mentioned his pancreas, then it'd be worth thinking about an ultrasound. This is a very good non-invasive tool that can allow us to assess the pancreas as well as rule out other GI issues (ie IBD, GI cancer, etc). It also will let us check all his other organs are as they should be.
Overall, your lad's signs and failure to settle with this treatment and the fact that diarrhea can be caused by so many other issues; I would suggest looking into this more for Tigger. Ideally, we'd want to take the above step-by-step approach here. So, consider a fecal test and/or worming at this point. These can both be done before having him back to your vet. Depending on the findings of these, if clear, then you may want to have him reassessed and speak to his vet about these other concerns and narrowing down these so we can definitively diagnose the cause and address them effectively for him.
All the best,
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