Kitten with chronic diarrhoea

Re: Kitten with chronic diarrhoea

Michael Woodhouse — Sat, 12 Apr 2014 18:48:18 GMT

[quote user="Anthony Todd"]I don't think I, ever used steroids on a diarrhoea case ever, which may surprise you, maybe I should have.[/quote]

Can make a real difference in puppies once the cause has been dealt with. Some must have chronic gut thickening. We'd only use them when the faecal results are clear for all causes.

If they are going to help the results can be dramatic.

Re: Kitten with chronic diarrhoea

Anthony Todd — Sat, 12 Apr 2014 12:29:29 GMT

[quote user="Martin Atkinson"]At least you haven't suggested steroids yet Anthony![/quote]

I don't think I, ever used steroids on a diarrhoea case ever, which may surprise you, maybe I should have.

Re: Kitten with chronic diarrhoea

Richard Carter — Sat, 12 Apr 2014 11:50:55 GMT

[quote user="Martin Atkinson"]At least you haven't suggested steroids yet Anthony![/quote] Actually as this is chronic there will be secondary changes with inflammatory infiltration and disruption of the lacteal and villi structure and function so by now steroids are fully justified to stop the gut pumping out / leaking fluid. The only problem is if the disputed tora virus is having any role but if a trial treatment of preds is tried and there is no response fairly raipidly (3 - 5 days) these can easily be stopped again.

Re: Kitten with chronic diarrhoea

Anthony Todd — Sat, 12 Apr 2014 11:35:14 GMT

[quote user="Martin Atkinson"] not to starve as the intestine needs [/quote]

You may be right, although just 24 hours of water wouldn't really make that much difference to the animal's nutrition and it gets the owner on message and makes this normal animal ready to eat plain boiled chicken or fish after probably all sorts of high fat diets and liquids.

You would be surprised how seldom the diet trial approach is used first up in these days of diagnosis using some sort of test or tests prior to any sort of treatment. [the OP makes no mention of it either.]

It's really difficult to get the owner to understand too which is why I gave the full instructions! ["only a small dish of ice cream"]

As a multitude of treatments have been tried [apart from B12] it seemed obvious to go back to basics which is so out of favour these days.

Of course, if the D+ continues and you are sure the diet trial has been followed to the letter, then look for the other causes but not the other way round.

This is in a happy, normal, active animal, not vomiting and no gut pain etc., which others seem not to understand.

The best example for my repetition is a cat vomiting after food for months which ended up with me, bill to date "over £3000". A locum at the other practice had noted "only vomits after dried food" which had been ignored, leading to stomach and intestinal biopsies etc.

Eliminating dried food stopped it!

Re: Kitten with chronic diarrhoea

Martin Atkinson — Sat, 12 Apr 2014 11:15:04 GMT

[quote user="Anthony Todd"]

Oh dear, you're going to be medicating a lot of happy, healthy, chronic diarrhoeas for ever then.

Mind you the owners, in desperation, may try a diet exclusion, so it may stop in the end.

[/quote]At least you haven't suggested steroids yet Anthony!

For sure your approach will work in 99% of first presentation cases but the general rule now is not to starve as the intestine needs at least part of its nutrition from food in the gut so starving may mean there's less shit to clear up but it doesn't necessarily expedite recovery.

But I feel sure the OP has already done the conservative approach and it hasn't worked and he/she is likely to have a desperate owner on his/her back who wants a bit more pro-active approach than it will get better in the end.

Re: Kitten with chronic diarrhoea

Neil Wheadon — Sat, 12 Apr 2014 10:14:15 GMT

Are you sure the owner is medicating? None return is an indicator. You could hosptalise and treat, though appreciate that there are cost implications. Neil

Re: Kitten with chronic diarrhoea

Richard Carter — Sat, 12 Apr 2014 09:25:31 GMT

so anyone seen a gap in the market for 'whole mouse in a can' yet??

When I was at college the talk was of opportunistic flagellates and metronidazole was the staple as was low dose cortisone to reduce the secondary IBD changes. Still seems to work now that we know of Trichs, giardia and bacterial overgrowth (and vit deficiency due to chronic fast throughput in colon)

Just finished the once a week Vit B12 x 4 in a border with excellent results that had d+ for over 3 months, no response to anything else including starving, kaolin and probiotics, resticted food trials, trial fenbendazole, abs, steroids etc. in more or less that order.

Re: Kitten with chronic diarrhoea

Anthony Todd — Sat, 12 Apr 2014 07:31:54 GMT

[quote user="James Laidlaw"]So chronic diarrhoea isn't "ill-health"? I'm not really gonna discuss this any further.

[/quote]

Oh dear, you're going to be medicating a lot of happy, healthy, chronic diarrhoeas for ever then.

Mind you the owners, in desperation, may try a diet exclusion, so it may stop in the end.

Re: Kitten with chronic diarrhoea

James Laidlaw — Sat, 12 Apr 2014 00:43:31 GMT

So chronic diarrhoea isn't "ill-health"? I'm not really gonna discuss this any further.

Re: Kitten with chronic diarrhoea

Rob Loxley — Fri, 11 Apr 2014 23:34:35 GMT

[quote user="Jscvet"]ronidazole (v expensive though[/quote]

You can now get this much cheaper, off the shelf (from Summit, if I remember correctly)

and +1 for looking for trich, however agree some of these are plain frustrating...

Re: Kitten with chronic diarrhoea

Jscvet — Fri, 11 Apr 2014 23:23:47 GMT

Would it be worth testing for tritrichomonas? I've had this in a couple of chronic d+ cases in young cats- one cleared up totally with ronidazole (v expensive though as has to be formulated specially for each case). Maybe it's this causing the ongoing problem even though there have been positive results for giardia etc? Probiotics also very useful as an adjunctive therapy for these (as well as dietary management already suggested). :)

Re: Kitten with chronic diarrhoea

Anthony Todd — Fri, 11 Apr 2014 21:41:10 GMT

[quote user="James Laidlaw"]Some of the findings may be incidental, but suggesting such a case is healthy, or happy, is just plain ridiculous. In broadly in agreement with Bob and Martin if you want my opinion on the case.

[/quote]

I reread the history; no mention at all of any ill-health or unhappiness.

Lots of animals with chronic diarrhoea are very happy although their owners are far from it.

As some of the posters have mentioned the lab. findings as "incidental" I'm happy to suggest the simple and obvious things first, which, as I have said, have a remarkable success rate.

C B at Florida once told me that 90% of his referred chronic diarrhoeas turn out to be dietary intolerance.

Re: Kitten with chronic diarrhoea

Ceri Gruffudd Jones — Fri, 11 Apr 2014 21:32:16 GMT

Dietary management is vital. Also, Vit B12 injections can be really helpful in chronic D+ cases.

Re: Kitten with chronic diarrhoea

James Laidlaw — Fri, 11 Apr 2014 20:57:20 GMT

Some of the findings may be incidental, but suggesting such a case is healthy, or happy, is just plain ridiculous. In broadly in agreement with Bob and Martin if you want my opinion on the case.

Re: Kitten with chronic diarrhoea

Anthony Todd — Fri, 11 Apr 2014 19:13:17 GMT

24 hours on water only, then boiled chicken or boiled fish only, water ad lib, NO MILK, until passing a formed stool if not after say 4 days then start looking for the weird and wonderful.

Keep cat/dog in and make sure no family member is not feeding it other stuff or giving it "just a bit of milk".

Too easy, too cheap, always successful but dinosaurial.

This is in a healthy happy animal with the squits, not one that's unwell.

Re: Kitten with chronic diarrhoea

Martin Atkinson — Fri, 11 Apr 2014 18:08:54 GMT

The Giardia, Cryptosporidiosis and Clostridia may all be incidental findings and not clinically significant especially if its just on PCR but worth treating again anyway. But you have to ask what condition this cat is being kept in, what is the hygiene, contacts are like etc. Coronovirus diarrhoea can go on for ages and IMO is often very watery and brown whereas that associated with the other things tends to be soft and pale +/- blood. Also consider FIP if it has FCoV so maybe a FCoV/FIP titre and proteins/SPE plus blood count. I presume she is on a bland diet for management and you've done probiotics (if not give at least 3 weeks the gut flora can take a long time to recover) but maybe worth thinking about a food sensitivity and thus an exclusion diet.

Re: Kitten with chronic diarrhoea

Bob Russell — Fri, 11 Apr 2014 18:02:14 GMT

Keep repeating the fenbendazole for at least seven days every month. Cheap as can be. I would suspect the coronavirus will be self limiting. clostridia possibly related to chronic intestinal problems rather than a specific cause. I am convinced giardia is more than an opportunist! Would avoid further antibiotics at this stage.

Digestive or hypoallergenic diet, probiotics? not a bad idea.

The in house giardia test works well for us!

Probably be shot down in flames but not failed to get one to settle for years. Actually the last one that did not do well belongs to the local traffic warden and happened before we used the giardia test routinely on this type of case. These are not uncommon problem cases IMO. Monitoring regularly for giardia allows you to monitor the cat rather than have them drop off the radar.