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my cat has had diarrhea for a month. tests on stool sample

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my cat has had diarrhea...
my cat has had diarrhea for a month. tests on stool sample and blood work have found no problems. he has ibs and pancreatitis but has been on medication for these for over a year with great success. what other medical issues should i consider? could pancreatitis flare up even though he's taking pancreenyme daily?
we also got a dog a few weeks before the diarrhea started. if his problem is behavioral would the diarrhea start weeks after getting the dog and last for another 4 weeks?
any suggestions / ideas greatly appreciated.
also, do you know of the effectiveness of plantaeris to treat diarrhea? a natural supplement i've found online with good reviews.
propectalin, prescribed by the vet is not working to help diarrhea.
Submitted: 8 years ago.Category: Cat Veterinary
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8/27/2009
Cat Veterinarian: Dr. Bethany Tapp, Veterinarian replied 8 years ago
Dr. Bethany Tapp
Dr. Bethany Tapp, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 15
Experience: UGA '98 graduate of School of Veterinary Medicine
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Is she on any medications other than pancreazyme and propectalin? If so what are they and what dosages?

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Customer reply replied 8 years ago
no, only pancreazym and propectalin
Customer reply replied 8 years ago
he has also urinated outside the box 3-4 times in the last week. if this is stress related, would / could the diarrhea last for 5 weeks?
Cat Veterinarian: Dr. Bethany Tapp, Veterinarian replied 8 years ago

Thanks for the additional information. Pancreatitis and IBD are difficult disease to manage in cats. I'm assuming your cat has a firm diagnosis of pancreatitis and IBD and not just differential diagnosis (on the rule out list but not confirmed with any test). As you probably know they are usually managed not cured. Sounds like you've done a fair amount of research on your own. Good work. The pancreazyme is supposed to provide enzymes the pancreas would normally make as a result the pancreas doesn't have to work as hard. The propectalin is like eating live growth yogurt. I replenishes the good gut bacteria that is killed off by bacterial overgrowth from diarrhea. I wouldn't expect the diarrhea to be related to the dog since he was there a month before the diarrhea started. However diarrhea lasting 4 weeks can be stress related. IBD (liken this disease to inflammatory bowel syndrome in people) can be stress related. Both diseases are inflammatory processes and sometimes require steroids (anti-inflammatory drugs) to control the outbreaks (sometimes chronically or long term). Steroids of course come with their own list of side effects and you and your vet would need to discuss the pros and cons to determine if they would be indicated in your case. Metronidazole is an antiboitic that will help flare ups of IBD. It can not be given in the face of any liver problems. It does work great with diarrhea to aid in getting the gut bacteria back in sync. Vitamin B12 or B complex would be helpful in this case. Acute pancreatitis is more common than chronic pancreatitis -- keep this in mind. I have no personal experience with the supplement plantaeris. I searched it on my veterinary forum which does have alternative medicine veterinarians online and no comments have been made other than people (not vets) are mentioning it online. I'd recommend not trying the supplement without know ALL potential side effects and drug interactions. I always wait 6 months to a year after a new drug comes out for the company to work out all the kinks. I don't want to use my patients as guinea pigs.

The urinating outside litter pan can be related to stress from diarrhea, behavioral stress, urinary tract infection, or not being happy with the litter or cleanliness of the pan. Yes, diarrhea can last 5 weeks. You should be concerned about dehydration and the effects it could be having on his kidneys.

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Customer reply replied 8 years ago

he received a depomedrol /b12 shot ten days ago and has been getting this every 6 weeks or so for about two years to treat the ibs. it has not seemed to help the diarrhea. could the diarrhea be caused by the switch to z/d food? what other tests would you reccomend? i'm considering the test to re-check his pancreas function (tpi and lpi, i think it's called). this is however pretty costly. could the pancreazyme have stopped being effective in treating his pancreatitis. when he was first diagnosed with pancreatitis the syptom was the same type of diarrhea, however the pancreayme cured him, until his recent mysterious flare up of diarrhea. he is eating and drinking normally and does not seem to be feeling bad. both the ibs and pancreatitis were confirmed through tests about 2 years ago. what test or next step would you suggest if he were your patient?

thanks for your help. i want to be thorough in my search for a cause.

Customer reply replied 8 years ago

my previous question is that last i will ask. if you could respond to this last question i would greatly appreciate it and i'll be sure to "accept" it, so the funds are transfered. thanks so much for your time and this great service.

p.s. i'm thinking of going to vet school at 36 years of age. where is UGA?

Cat Veterinarian: Dr. Bethany Tapp, Veterinarian replied 8 years ago

The depo and b12 shots are great! You may want to consider increasing the frequency up to every 4 weeks during flare ups. I would have expected him to respond to the recent injection 10 days ago though if this was all inflammatory. I would not expect z/d to cause diarrhea. It is a very benign diet with very small proteins and carbohydrates for allergies. If he were my patient I would start from the beginning again as continuing to treat the pancreatitis and IBD has not managed this current bout of diarrhea. I would start with a simple fecal exam 1)look for intestinal parasite eggs especially coccidia which like to come and go with stress and 2)a direct smear to look for giardia (which also like to come and go with stress) and numbers of protozoa. If I saw large numbers of protozoa I would treat with metronidazole. Protozoa are not necessarily a primary cause of diarrhea but are frequently complicators. They are always around and like to seize the opportunity to come in a wreak havoc leading to new problems such as bacterial overgrowth. Pets can be carriers of giardia and coccidia. When not stressed they encyst and are latent causing no problems. When the pet is stressed, they
"come back to life" and typically cause diarrhea and sometime vomiting. Metronidazole also treats giardia. Albon treats coccida. I would run a CBC to look for an elevated (bacterial infection) or decreased (viral or severe bacterial infection to the point of septicemia--(infection in the blood stream)) white blood count. If his biochemical tests are older that 6 months I would repeat these to make sure no new disease processes have crept into the picture such as liver or kidney diseases. If nothing came up on these I would submit the tests for pancreatitis first. Texas A&M has the "be all" test for this (GI panel at TAMU). You're right this checks for TLI, cobalamine, folate and fPLI. I would confirm the pancreatitis before throwing more pancreatitis medications at him. The monetary and time costs of just trying things like cobalamin, SAMe and actigall just to see if they work would be more stressful for you and your pet than confirming the diagnosis (cause of his current diarrhea flare up). Sorry it took me awhile I wanted to be very thorough and be sure to answer all your questions and any potential questions I may have stirred up. UGA is in Athens, GA (University of Georgia Veterinary School). 36 is not too old to start. There were 3 people in their 40's while I was there. The oldest was 46.

Dr. Bethany Tapp
Dr. Bethany Tapp, Veterinarian
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Experience: UGA '98 graduate of School of Veterinary Medicine
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Customer reply replied 8 years ago

thanks so much for your time. his CBC was done last week and showed nothing abnormal. am i correct in understanding that you would next do the test to check pancreas function, which was last done over one year ago? this is a great service, thanks for your "second opinion" and helping make my decision in how to procede.

david

Customer reply replied 8 years ago

thanks so much for your time. his CBC was done last week and showed nothing abnormal. am i correct in understanding that you would next do the test to check pancreas function, which was last done over one year ago? this is a great service, thanks for your "second opinion" and helping make my decision in how to procede.

david

Cat Veterinarian: Dr. Bethany Tapp, Veterinarian replied 8 years ago
No, the next test would fecal analysis - a float and direct smear. Then a biochemical panel (unless you've had one within the last 6 months). If nothing abnormal shows on the biochemical panel or if it is current within the last 6 months I would run the pancreatitis test. I certainly wouldn't want to step on your vet's toes though. I'm simply giving you my opinion if I saw your cat in practice today. It does sound like your vet is on top of things. Pancreatits and IBD are difficult to diagnose.
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Customer reply replied 8 years ago

Dr Tapp -

Thanks so much for your information, you helped ease my mind and decide what to do next. I took "Boo" in today for blood to be drawn and we are checking his pancreas function. One question arose that I hope you can give your opinion on. My OLD vet diagnosed "Boo" with pancreatitis and prescribed Pancreazyme over two years ago. The OLD vet originally told me that the Pancreazym needed to be sprinkled onto food and left to sit for 20-30 mins before the cat ate the food. My cat would not eat the food with the Pancreazyme mixed in. I called to OLD vet with this information and the person who answered the phone put me on hold and came back and told me that the Pancreazyme could just be given orally as a pill. My NEW vet insists that the Pancreazyme given orally as a pill is not effective at all. The NEW vet insists that this medication has to be mixed with food, left to sit for 20-30 mins before the cat eats it. She says that the Pancreazyme pill I have been giving my cat orally for two years has done nothing to help his pancreatitis. She says that since his symptoms did clear up, it had to have been the Depomedrol shots he gets once a month that is helping with the pancreatitis, not the Pancreazyme. What info do you have on how this medication can be given and if giving it orally is effective or not. The pills are brown, round, flat, scored, and have the number 102 stamped on them. Thanks for any advice.

David

Cat Veterinarian: Dr. Bethany Tapp, Veterinarian replied 8 years ago
It does depend on what kind of pill it is. The label and package insert should be very clear about how to administer this medication. I'm assuming you have the original container and if you don't then ask your vet if they can provide you with a copy of the package insert. Before pancreazyme clients were instructed to sprinkle meat tenderizer over the food and let it set. The tenderizer would begin to "digest" the food before the pet even started eating it. I can't remember the last time I prescribed pancreazyme. I recall it was a pill and not a powder sprinkled over the the food. There are probably different products available. This 'treatment' regime has been around forever. I tend to agree with your NEW vet about the pancreatitis clearing up more with the steroids. Pancreazyme doesn't TREAT pancreatits. The idea behind it is that it's giving the pancreas a chance to rest and heal by doing the job of the pancreas. Hope that's clear. Don't forget to check your kitty's stool with a fecal float and direct smear. You've got to have confidence in your vet. I haven't read anything that sounds strange or questionable.
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