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Chronic diarrhea for 8.5 years. Liver, kidney, and thyroid…

Chronic diarrhea for 8.5...

Chronic diarrhea for 8.5 years. Liver, kidney, and thyroid test okay, he's had full blood work ups, ultrasound, and surgical investigation, everything comes up normal, but his diarrhea is horrible smelling, and comes with very painful gas build up

Veterinarian's Assistant: I'll do all I can to help. What seems to be the problem with the cat?

You
chronic diarrhea for 8.5 years. Liver, kidney, and thyroid test okay, he's had full blood work ups, ultrasound, and surgical investigation, everything comes up normal, but his diarrhea is horrible smelling, and comes with very painful gas build up

Veterinarian's Assistant: Where does the cat seem to hurt?

In his abdomen, you can see and hear him. When a gas bubble moves in his gut, he will cry and curl up tighter, similar to a human who has severe gas build up.

Veterinarian's Assistant: OK. The noise must be worrying. I'll connect you to the Veterinarian. What is the cat's name?

Bananas

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Bananas?

We have ruled out bacterial, and he is currently being treated with pancreatic enzymes to see if they help, but he's getting very little improvement and would rather starve than eat food with the enzymes on it

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Answered in 8 minutes by:
9/5/2017
Dr B
Dr B, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 2,359
Experience: DVM
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HI this is DRB and I would be happyto help you with this....so I hear there has been a big work upbut has there been any therapeutic challenges?

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So has any Dr tried your cat on Budesonide medication?

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Budesonide is a steroid that stays primarily in the gut and it cures 99% of diarrhea in cats.....I am assuming your vet has checked for parasites??

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I would put your cat on Science diet low allergen ZD food if he will eat it and on Budesonide.....this will usually fix most cats......your cat may have inflammatory bowel disease not showing up on tests......

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I am happy to answer any questions that you have.....just let me know what you have questions about..I will be online for another 1-1.5hours.....DRB

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If you do not have any other questions please rate me as this is how I make money to support my family. Please give me a positive rating as that is the only way I am compensated. A positive rating will not close this question and I am more than happy to answer any follow up questions that you have. ( You can rate me at top right of page).

Please remember my answers do not replace or supersede the advice of your veterinarian as my answers do not create a valid client patient relationship as I am unable to examine your pet. Thank you very much! DrB

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Customer reply replied 9 months ago
We have tried him on budesonide to no effect. He was eating Hill's Z/D dry food and benefitted slightly, until they changed their formula last year. The "new and improved" Z/D formula food caused the diarrhea to return and also caused him to present with vomiting, and our other cats also got very sick on the "improved" formula. Since then he has tried many hydrolyzed protein prescription foods to no avail.

Have you tried Purina HA food with metronidazole?

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Customer reply replied 9 months ago
I do not know if this is significant or not, but Bananas never had diarrhea or smelly poo until he was neutered. He returned home from the surgery with diarrhea, that was 8.5 years ago of course. We have tried the Purina HA food, and metronidazole, both had no benefit. Purina HA caused his poo to smell slightly less and change color from darker brown to a lighter brown. We've tried him also on Purina Fortiflora, which he loved eating but it gave him no benefit

Have you seen an internal medicine specialist?

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Customer reply replied 9 months ago
We took him to the internal medicine and diagnostics veterinarians at University of Georgia 2 years ago. They did the ultrasound and investigational surgery which found nothing. Bloodwork showed nothing, so they recommended the Hill's Z/D food and said they couldn't do anything further. As I said, the ZD food helped him some (the explosive-ness, inability to make it to the litter box, and severe gas lessened, but the smell and consistency remained) until they changed the formula. A few weeks ago his vet finally decided to try pancreatic enzymes thinking it may be pancreatic insufficiency, and the enzymes have helped some, but he would rather starve than eat food that has the enzymes on it.

I personally would put him back on ZD.....and add Budesonide and metronidazole both at the same time.....also add Ursodiol to protect the liver....and do this for 8 weeks and then reassess....

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just to be on the safe side would probably be good idea to do 2 weeks of ronidazole first and then go to what I have said above....Ronidazole txs some odd parasites that can be hard to find and tx...

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If your cat has been tested for exocrine pancreatic insufficiency with TLI test which I am sure he has.....then no point in pancreatic enzymes....

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Customer reply replied 9 months ago
The new formula of ZD made his diarrhea worse than ever and made him vomit. He went from having a decently healthy coat and mildly overweight to having a coat that looked like he rolled in cooking grease all day and losing pounds in days. I won't ever touch the new "improved" formula of ZD again, especially since my other healthy kitties developed the same problem (they were all fed the same food at that time). Is the Royal Canin hydrolyzed protein a viable alternative?He tested on the low end of normal for pancreatic enzyme function, but because he was still within "normal" range, UGA dismissed it. His current vet did not dismiss it, and the enzymes have helped him, except he hates eating them.

I would do 2 weeks Ronidazole, then follow with science diet ID ( INtestinal diet) and do budesonide and also metronidazole at the same time.....

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will he canned food?

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Customer reply replied 9 months ago
he does eat canned food. We are currently feeding him purina kitten chow dry and fancy feast cans, as they are the only thing he even picks at with the enzymes on it. The dry food is pretreated with the enzymes and all kitties have access (they all get sick if they don't have free range access to dry food). All kitties have handled that dry food well. We do twice a day canned feedings, Bananas is fed in a separate room with enzymes added, the other cats do not get enzymes on theirs. Bananas does not want to eat the canned food with the enzymes but will pig out on any non-treated canned food. Before proceeding with your suggestion, is there a safe alternative way to give him the enzymes with canned food, such as through a capsule with each meal or by mixing the enzymes in chicken water and syringe feeding that to him with his meal?

If you can get him to eat canned food then you could mix the enzymes in with the canned food ( science diet Intestinal diet or the Royal canin intestinal diet),then add budesonide and metronidazole...sometimes it takes multiple things to "fix" a patient...

sorry I did not answer your other question....no neutering would not cause this...but since he has had the diarrhea so long...I would definitely do Ronidazole first...

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Customer reply replied 9 months ago
I don't think we've ever tried the ronidazole before, so I will ask about that. If he won't eat canned food that has the enzymes on it, but will eat plain canned food, is there a safe alternative way to give him the enzymes with the meals?

You could have your vet called diamondback pharmacy which is a vet compounding pharmacy and they may be able to compound the enzymes....

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I would definitely do Ronidazole as there is no down side.....

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14-21 days of Ronidazole just to make sure we not missing the obvious...

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Customer reply replied 9 months ago
I will try that and ask about the ronidazole and combination that you suggested. One last question, I know the gas "pockets" that move in his abdomen and cause him pain are awful, he cries when they move, and you can tell every time he poos he is miserable, if we try all of what you've mentioned, and get no resolution, is there a point at which you would suggest that he is suffering and needs put down? Right now he has lost some weight, but is still a very healthy weight, his coat is good, it's just the diarrhea and gas pains that get him, plus sometimes he doesn't get warning and doesn't make it to the box, sometimes a fart is actually not just a fart....I don't want him to go, but I would never want him to suffer needlessly either....

and I would get him back on an intestinal diet...with that diarrhea he needs to be on an intestinal diet FOREVER .....no advantage to ever coming off this.... let me give you link to royal canin diet I would recommend...give me a sec....

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I will answer your last question in a sec...

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In summary, only the above food, 2-3 weeks of ronidazole, then continue above food and use budesonide and metronidazole (at anti-inflammatory dose) simultaneously....

one last thought....I would also consider doing 6 weeks of oral azithromycin liquid after ronidazole but before budesonide and metronidazole...your cat could have Bartonella causing GI disease which will not show upon tests.....

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but during all this stay with the food I mentioned...

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if you do all of the above with no result then yes I do believe you should consider euthanasia.....

don't forget Ursodiol when doing budesonide and metronidazole......

do you need me to summarize again?

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Customer reply replied 9 months ago
switch to the recommended royal canin, do 2-3 weeks of ronidazole (I'd go for 3 to be thorough), then 6 weeks of oral azithromycin, then 6-8 weeks metronidazole and budesonide with ursodiol to protect the liver? That's your suggested course of action, with euthanasia if unsuccessful. 2 questions, is the suggested royal canin food safe for growing kittens (have 2 that are 13 months and 1 5 month old)? And would Bananas need to be separated from the other kitties during treatment? Thus far he is the only one with symptoms, never had another kitty seem to have gotten sick from him.

all good except I would probably do 8 solid weeks of last part (budesonide and metronidazole)......

yes,all kittes can eat that food....

no need to separate...Bartonella not easily passed.....but if no one else has symptoms then you can skip Ronidazole and go straight to azithromycin...because everything that that would kills very contagious....

so.....the other thing I would do is maybe go ahead and start Metronidazole at anti-inflammatory dose of metronidazole when doing azithromycin....let me summarize once more..

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so.....start new royal canin food....do metronidazole at 10-15mg/KG twice daily......and azithromycin at same time ( Zith for 6 weeks). After done with Zith start Budesonide.....

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that should cover everything.....

any other questions??

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If you do not have any other questions please rate me as this is how I make money to support my family. Please give me a positive rating as that is the only way I am compensated. A positive rating will not close this question and I am more than happy to answer any follow up questions that you have. ( You can rate me at top right of page).

Please remember my answers do not replace or supersede the advice of your veterinarian as my answers do not create a valid client patient relationship as I am unable to examine your pet. Thank you very much! DrB

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let me know if you have additional questions...DRB

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Customer reply replied 9 months ago
In your medical opinion should he continue to be given the enzymes during the above treatment, or the enzymes stopped? If he should continue enzymes during the above treatment and the treatment works, should he continue enzymes after the above treatment is concluded?

If you can get him to eat with enzymes mixed in food there is no downside....to using them....but if not eating well I would discontinue them,....

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Customer reply replied 9 months ago
Okay. Is there a way to contact you directly with the treatment results so you can see how everything worked out? Otherwise I have no other questions

No, there is no direct way...except you can come back to this site and ask for me.....and I will see the question unless I am on vacation...I would love to know what happens......you can pay a very small fee to ask for me....we are not allowed to share personal info....

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Customer reply replied 9 months ago
Okay thank you very much, I will get with his regular vet about your suggested treatment and keep you updated after treatement

super...best of luck!!

Dr B
Dr B, Cat Veterinarian
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thank you very much......

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Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr B
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