Chronic Diarrhoea in a cat

RE: Chronic Diarrhoea in a cat

Anthony Todd — Wed, 18 Jul 2018 23:58:00 GMT

[quote user="robloxley"]Do you always want a short term response over a long term solution, however...[/quote]

Yes, always have, always did. Relieve "suffering" ["suffering in the broad sense] while concurrently finding/treating/removing/achieving resolution of the cause, not in the reverse order.

Or better, immediate relief then solution if possible and different.

This is the main and fundamental difference between a modvet and a dinovet in this context.

RE: Chronic Diarrhoea in a cat

Rob Loxley — Wed, 18 Jul 2018 22:39:26 GMT

[quote user="Anthony Todd"]all-pervading fear and distrust of "the 'roids"[/quote]#

I really do think a lot of this is in your mind.
I'm sure most here understand and use wisely the tools they have available and - to borrow phrasing - have more tools for the different screws they see than a single hammer

[quote user="Anthony Todd"]You are trying to get an obvious and rapid response for three reasons; it's obviously good for the animal, it assures you that you are on the right track and it encourages the owner to continue with your recommendation and treatment as they can see this immediate and obvious response, as you can[/quote]

Do you always want a short term response over a long term solution, however...

RE: Chronic Diarrhoea in a cat

Anthony Todd — Wed, 18 Jul 2018 21:24:46 GMT

[quote user="robloxley"]I asked if you had any evidence of the difference in efficacy between oral and injectable steroids if given at equivalent doses (which a quick look in the formulary will tell you what relative potency is)?[/quote]

Yes, I understood that but usually, as quoted on here, and with the all-pervading fear and distrust of "the 'roids" the dose of pred is nowhere near the maximum which I think is incorrect and inadequate certainly initially. Often in the posts there is even an apology for even mentioning the use of c'steroids!

You are trying to get an obvious and rapid response for three reasons; it's obviously good for the animal, it assures you that you are on the right track and it encourages the owner to continue with your recommendation and treatment as they can see this immediate and obvious response, as you can.

RE: Chronic Diarrhoea in a cat

Liz Barton — Wed, 18 Jul 2018 21:20:46 GMT

[quote user="Anthony Todd"]Of all the groups of drugs available, then or now, corticosteroids are regarded by most modvets as dangerous addictive drugs with serious permanent side effects only used by people too lazy or inept to achieve a proper diagnosis, and always supported by exaggerated examples of gross misuse or toxicity.[/quote]

I doubt this is a commonly held misconception Anthony. With the overlap between inflammatory disease and cancer clinically and on imaging, we always have the discussion with owners regarding holding off steroids until we decide if we want to biopsy or not.

Here's a controversial one - we've had several cases of cats in a rehoming centre which have responded well to raw diet. This is AFTER all the obvious such as worming, a fully controlled diet trial with hydrolysed diet or hypoallergenic food and faecal analysis. We've even had an EPI confirmed cat, which improved on raw diet alone.

RE: Chronic Diarrhoea in a cat

Rob Loxley — Wed, 18 Jul 2018 21:05:33 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]Do you have any evidence for this, if equivalent doses are given by injection or orally? [/quote]

Only some years of seeing many obvious responses [or not] after injections of more potent corticosteroids in around 24 hours or less often after a feeble inadequate course of oral pred.

[/quote]

I asked if you had any evidence of the difference in efficacy between oral and injectable steroids if given at equivalent doses (which a quick look in the formulary will tell you what relative potency is)?

RE: Chronic Diarrhoea in a cat

Anthony Todd — Wed, 18 Jul 2018 20:18:52 GMT

[quote user="robloxley"]Do you have any evidence for this, if equivalent doses are given by injection or orally? [/quote]

Only some years of seeing many obvious responses [or not] after injections of more potent corticosteroids in around 24 hours or less often after a feeble inadequate course of oral pred.

Usually, as in the current example, the dose and drug quoted is nowhere near the maximum single dose which is added to the vagaries of oral administration, particularly with an inexperienced owner.

Of all the groups of drugs available, then or now, corticosteroids are regarded by most modvets as dangerous addictive drugs with serious permanent side effects only used by people too lazy or inept to achieve a proper diagnosis, and always supported by exaggerated examples of gross misuse or toxicity.

RE: Chronic Diarrhoea in a cat

Rob Loxley — Wed, 18 Jul 2018 19:50:35 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]I would consider a higher dose of prednisolone, some IBD cases need to start on 2mg/kg/day to settle them down.[/quote]

Why, oh why, do people start what is actually a "diagnostic" steroid with [a] an oral dose of a minimally effective drug, and with all the vagaries of oral administration and [b] not use an injection of a more potent derivative?

[/quote]

Do you have any evidence for this, if equivalent doses are given by injection or orally?
We start IMHA, IMTP, IMPA, IBD cases etc. on preds and see response. My understanding is that dexamethasone is associated with a higher incidence of adverse GI effects than prednisolone, but may have potential advantages with less sodium retention (may be relevant if CHF, hypertension, or excessive PUPD on pred), but nothing regarding differing efficacy?

RE: Chronic Diarrhoea in a cat

Anthony Todd — Wed, 18 Jul 2018 17:55:16 GMT

[quote user="Thomas Johnson"]I would consider a higher dose of prednisolone, some IBD cases need to start on 2mg/kg/day to settle them down.[/quote]

Pred is great for intermittent use in chronic, recurring, skins, and with an adjustable dose rate but, IMHO, poor in an acute diagnostic "will it/did it respond" situation.

RE: Chronic Diarrhoea in a cat

Thomas Johnson — Wed, 18 Jul 2018 16:22:32 GMT

[quote user="Anthony Dennison"]I tried a course of prednisolone at 1mg/kg/day. No difference.[/quote]

I would consider a higher dose of prednisolone, some IBD cases need to start on 2mg/kg/day to settle them down.

RE: Chronic Diarrhoea in a cat

Anthony Dennison — Mon, 16 Jul 2018 17:54:33 GMT

[quote user="Anthony Todd"]What happened??[/quote]

Patience Tony. I only saw it 5 days ago, going to wait a full week at least to see if the Psyllium helps.

RE: Chronic Diarrhoea in a cat

Anthony Todd — Mon, 16 Jul 2018 17:17:25 GMT

[quote user="Anthony Dennison"]I've been treating a 9 year old MN British Shorthair that has had varying severity of diarrhoea for almost 5 years[/quote]

What happened??

RE: Chronic Diarrhoea in a cat

Kate Richardson — Thu, 12 Jul 2018 22:53:08 GMT

[quote user="Jenny Boyd"]

I have diagnosed EPI in several cats....

[/quote]

Definitely have on the radar but they lose weight with this and this cat has gained? If i read correctly.

Agree with Martin, likely chronic changes such as villous atrophy. Diet most important-easily digestible non inflammatory, B12, probiotics, however despite my comment above, no harm in trialling pancreatic enzymes but diet still most likely key. But may never revert to normal if chronic irreversible changes which biopsy may tell you and give O an answer but may not change what you do (personally wouldnt be going there)

RE: Chronic Diarrhoea in a cat

Jenny Harris — Thu, 12 Jul 2018 14:30:36 GMT

I have diagnosed EPI in several cats....

RE: Chronic Diarrhoea in a cat

Rob Loxley — Thu, 12 Jul 2018 14:00:29 GMT

Anyone using much Questran for chronic, difficult diarrhoea cases?

RE: Chronic Diarrhoea in a cat

Martin Atkinson — Thu, 12 Jul 2018 12:32:59 GMT

First thought that if this cat has had diarrhoea for 5 years it is neither neoplastic nor an infection, I suspect the Tritrich is incidental and your Rodinazole has has just an immunomodulatory effect. Even if is significant the intestine may be so damaged if it has had it for so long it may never recover. If you're not going to do intestinal biopsies, and I suspect as you do it will come back as IBD, then a proper dietary trial is in order or if the owner isn't likely to comply then you could try it on a hydrolysed diet like RCW Hypoallergenic.

RE: Chronic Diarrhoea in a cat

Anthony Todd — Thu, 12 Jul 2018 10:17:39 GMT

[quote user="robloxley"]Proper diet trial?[/quote]

At last!

Having seen more diarrhoeas than most posters have had hot dinners, it continues to amaze and disappoint me that the rare and esoteric conditions are considered more likely than the common and obvious.

And that a "blood test", and a "work up", essential in some conditions, will, magically, reveal the cause.

Friends running practices now tell me the same thing, as does my GP!

I do hope that a dedicated single protein diet trial was the first thing tried, and just not mentioned.

RE: Chronic Diarrhoea in a cat

Julie Innes — Thu, 12 Jul 2018 08:56:09 GMT

I have a case like this- came from cat charity, no known background. The foster carer has been great, and willing to try lots of things! felv and fiv -ve, but a lecture I heard last year on FIP suggested that some cats with coronavirus present as chronic diarrhoea, especially pedigrees, so possibly something to think about?

I heard that applaws chicken and pumpkin was a good one for these cases. My cat didn't do great on that, but the fosterer procured some pumpkin paste from somewhere and the cat is doing really well with that and steroids as and when. We haven't done a full work up, as it's a small charity, but maybe some ideas?

RE: Chronic Diarrhoea in a cat

Rob Loxley — Thu, 12 Jul 2018 00:05:41 GMT

[quote user="Anthony Dennison"]Any other ideas?[/quote]

Proper diet trial?

Probiotic alongside ronidazole can reduce recurrence of Tritrich. If it has recurred and other co-infections ruled out, consider increasing dose rate (depending on what you 1st used)? See also http://journals.sagepub.com/doi/full/10.1177/1098612X17693499

RE: Chronic Diarrhoea in a cat

Jenny Harris — Wed, 11 Jul 2018 21:28:03 GMT

Also have you repeated the pcr for tritri?

RE: Chronic Diarrhoea in a cat

Jenny Harris — Wed, 11 Jul 2018 21:27:28 GMT

Have you checked a TLI?

RE: Chronic Diarrhoea in a cat

Anthony Todd — Wed, 11 Jul 2018 19:59:34 GMT

I'm sure you will have done done all the simple dinovet things like a single source of low fat protein, water only, and kept the cat totally in the [garage] and made sure grannie isn't giving the cat "just a little milk, 'cos it loves it"??

Won't be the first time a forensic exam turns up the cause......

PS even hospitalise it for a few days, just to make sure!

RE: Chronic Diarrhoea in a cat

Joyce Whitehead — Wed, 11 Jul 2018 17:58:20 GMT

How about a faecal transplant? Disclaimer that I've never tried it. But it’s used in people with chronic diarrhoea so may be worth a try before major invasive surgery? And I’ve heard some anecdotal reports of success in dogs at least. Anyone tried it?

RE: Chronic Diarrhoea in a cat

Bob Russell — Wed, 11 Jul 2018 17:57:26 GMT

If you can still get it, try Forgastrin. Charcoal based. Turns the poo jet black but does not seem to put cats off eating. 1/4 teaspoon mixed with each meal.

I assume it is negative for giardia?