Faecal transplant for cats

RE: Faecal transplant for cats

Anthony Todd — Thu, 21 May 2020 14:19:00 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222680"] just because no one has written about it means that it is out there just hasn't been discovered yet' is a bit tinfoil hat. [/quote]

Wasn't too far wrong when thalidomide was first raised, and dismissed [and, or because, by an Australian......]

RE: Faecal transplant for cats

Anthony Dennison — Sun, 17 May 2020 10:06:00 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222677"]Just search "congenital diarrhea of infancy", nothing is impossible, just not looked for, especially when very rare, so not yet diagnosed or looked for![/quote]

I'd rather use veterinary literature for advice and information on my veterinary work, rather than human medicine. But thanks anyway.

Journal of Veterinary Internal Medicine is open access. Perhaps you could search through that journal in the future for your references rather than trying to shoehorn human medicine information into your argument because it agrees with your way of thinkging. This is not how evidence based medicine works!

You asked for proof, of studies and information. It has been given to you, yet you refuse to acknowledge that because it doesn't agree with what you think. The thought process you are using of 'I think it's this, there's no evidence of it yet but just because no one has written about it means that it is out there just hasn't been discovered yet' is a bit tinfoil hat.

RE: Faecal transplant for cats

Anthony Todd — Sun, 17 May 2020 08:53:08 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222676"]Hope this is enough information for you to realise that a human neurological abnormality is unlikely to be seen in a cat. [/quote]

Just search "congenital diarrhea of infancy", nothing is impossible, just not looked for, especially when very rare, so not yet diagnosed or looked for!

RE: Faecal transplant for cats

Anthony Dennison — Sun, 17 May 2020 08:25:37 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222674"]Shut your eyes and imagine that cats may suffer from the same conditions as humans, 'cos they are sort of the same![/quote]

'Sort of the same' is not a good argument. I'm 'sort of the same' as a panda, as we're both mammals.

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222674"]That's because there ain't nuffing about cats ever been dun, or considered, FFS![/quote]

Well you know that's not true. There is plenty of research and investigations/publications in to diarrhoea in kittens, yet you can only seem to find a human paper to support your theory

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222658"] Could the gut [or parts of it] not had any nervous connection so couldn't do anything ever??[/quote]

Lack of nerve supply to guts is more likely to cause constipation rather than diarrhoea as the autonomous nervous system is involved with gut motility - see below:

https://journals.sagepub.com/doi/full/10.1016/j.jfms.2010.04.001

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222674"]Then someone has to write it up. Some conditions do exist that aren't in the literature yet!!![/quote]

There is another condition that affects certain purebreed cats (british shorthairs I think), that causes abnormal intestinal motility due to an issue with the parasympathetic nervous system, called Key-Gaskell syndrome (or feline dysautonomia). Again, causes constipation rather than diarrhoea. See below for a case report:

file:///C:/Users/Practice/Downloads/degeneration-of-autonomic-nervous-system-in-feline-dysautonomia-case.pdf

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222674"]But you have to look, or realise the above, and then someone has to realise that it is possible, in fact, given the signs and symptoms, pretty likely.....[/quote]

Diarrhoea is not likely to be caused by a congenital neuro abnormality - I hope the above literature helps you realise this. Dysautonomia will cause reduction in intestinal motility, whereas with diarrhoea there is an increase in motility and also increase in intestinal secretions causing the higher volumes of fluid passed.

Hope this is enough information for you to realise that a human neurological abnormality is unlikely to be seen in a cat.

RE: Faecal transplant for cats

Anthony Todd — Sat, 16 May 2020 21:57:01 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222671"]Human paper Tony. Not helpful. [/quote]

That's because there ain't nuffing about cats ever been dun, or considered, FFS!

Shut your eyes and imagine that cats may suffer from the same conditions as humans, 'cos they are sort of the same!

But you have to look, or realise the above, and then someone has to realise that it is possible, in fact, given the signs and symptoms, pretty likely.....

Then someone has to write it up. Some conditions do exist that aren't in the literature yet!!!

Maybe this is what this unfortunate cat had !?

PS. we had a pedigree cat with congenital [well from 6 months] incurable [obviously] megacolon.......

RE: Faecal transplant for cats

Anthony Dennison — Sat, 16 May 2020 16:52:16 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222658"]

Anything on congenital neurological deficiencies? Could the gut [or parts of it] not had any nervous connection so couldn't do anything ever??

This for start: gut.bmj.com/.../II60

[/quote]

Human paper Tony. Not helpful.

RE: Faecal transplant for cats

Anthony Todd — Sat, 16 May 2020 10:05:33 GMT

Anything on congenital neurological deficiencies? Could the gut [or parts of it] not had any nervous connection so couldn't do anything ever??

This for start: gut.bmj.com/.../II60

RE: Faecal transplant for cats

Kate Richardson — Sat, 16 May 2020 10:00:28 GMT

Yes always good to have balanced view to weigh up pros and cons. Have not done any myself as yet, so no personal experience. I think case selection is probably really important

RE: Faecal transplant for cats

Beats — Sat, 16 May 2020 08:45:45 GMT

Some less enthusiastic links and opinions re FMT (not related to case) for balance:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986962/

https://www.jwatch.org/na50261/2019/11/07/fecal-microbiota-transplant-identification-new-risk

https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-communication-risk-serious-adverse-reactions-due

https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-alert-regarding-additional-safety-protections-pertaining

https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-alert-risk-serious-adverse-events-likely-due-transmission

https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-communication-risk-serious-adverse-reactions-due

Ed Hall BSAVA Congress Proceedings 2020 (Probiotics and faecal microbial transplant: hype or hope?): "Personally, I don't think this is something that should be done in practice." 39.54

RE: Faecal transplant for cats

Kate Richardson — Fri, 15 May 2020 21:30:07 GMT

Horrible day. Virtual hug x

RE: Faecal transplant for cats

Joyce Whitehead — Fri, 15 May 2020 18:35:22 GMT

No we didn’t Anthony, we don’t keep them in stock. However it was included in the PCR panel the lab did and was negative. I was saying today it reminded me of some of those early parvo cases in the 80’s where the pups were left with no gut lining and took ages to sort. Poor Pete, he was a lovely little fellow but looked pretty grim today. It’s been a tough day, he was the first of 4 euthanasias.

RE: Faecal transplant for cats

Anthony Dennison — Fri, 15 May 2020 14:06:45 GMT

Sorry to hear this. Just as an aside? Did you ever try using a parvo snap test to see if it could be a parvovirus?

RE: Faecal transplant for cats

Kate Richardson — Fri, 15 May 2020 06:56:37 GMT

Oh so sorry to hear that, so sad when you’ve both invested so much effort and so young

RE: Faecal transplant for cats

Sara Ramsey — Thu, 14 May 2020 22:52:15 GMT

I am also sorry to hear that, I have been following this but had nothing helpful to add really. It's so horrible when you have been through so much with the patient and client.

RE: Faecal transplant for cats

Anthony Todd — Thu, 14 May 2020 22:36:46 GMT

Very sorry to hear that. I hope you can do a PM so something may be learned.

RE: Faecal transplant for cats

Joyce Whitehead — Thu, 14 May 2020 22:30:16 GMT

We gave him a shot of dex last week in a “nothing deserves to die without them” kind of thought. Sadly he has deteriorated markedly in the last 24 hours and I am putting him to sleep tomorrow. Sad but the owner is feeling he is suffering too much.

RE: Faecal transplant for cats

David Mills — Thu, 14 May 2020 21:48:49 GMT

Steroids?

RE: Faecal transplant for cats

Joyce Whitehead — Thu, 14 May 2020 13:12:14 GMT

Thanks Kate, we did a full PCR panel (he is thankfully insured) and all negative. I’ll see if we can get the probiotic, we will try it at least. I will keep biopsies in mind, I’m a bit cautious as he is low weight because of the recurrent diarrhoea.

RE: Faecal transplant for cats

Kate Richardson — Thu, 14 May 2020 10:08:57 GMT

And as have had a few requests for the faecal transplant info -can't attach the file so have copied and pasted:

FELINE FECAL TRANSPLANTS IN PRACTICE

Practical Use of Fecal Transplants for Gastrointestinal Disease

Letrisa Miller, MS, DVM

Introduction

Fecal transplantation (transfaunation) is a relatively new concept in veterinary medicine that can have dramatic results in the treatment of diarrhea. Theoretically, kittens and cats can develop an abnormal population of microbes inhabiting their intestinal systems which can result in chronic enteritis or diarrhea. While there is little direct research in cats so far, our clinic has had good results treating patients with presumed intestinal dysbiosis.

In humans, the most common cases of this type of illness are Clostridium difficile infections that are antibiotic resistant and are often associated with previous antibiotic use causing a change in normal intestinal flora. While chronic diarrhea in cats is very rarely associated with antibiotic treatment complications and the inciting cause of dysbiosis is usually unknown, fecal transplants have been successful in treatment of chronic diarrhea.

Patient Selection

In our practice, we have had the best resolution of diarrhea or other intestinal disease with careful selection of patients. Young cats with chronic diarrhea seem to benefit the most from this procedure, possibly because younger cats do not yet have chronic inflammatory changes or diarrhea directly related to the intestinal dysfunction often found in long term intestinal disease. Many older cats seem to have diarrhea due to long standing inflammatory bowel disease that has caused changes in motility as well as maldigestion or malabsorption, thus resulting in more complex disease.

Ideal cases are those younger than about 5 years old or older cats having a history of less than 1 year of diarrhea in my experience. It is ideal to screen patients by testing vitamin B12 and folate levels as well as pancreas-specific lipase (fPL) and serum trypsin-like immunoreactivity (TLI) to rule out pancreatic disease and low vitamin B12 as a cause of diarrhea. High folate levels are to be expected in those cats that have distal small intestinal dysbiosis, but not necessarily in those cats that have disease confined to the colon. Ultrasound can also be useful to identify severe intestinal changes or neoplasia that are less likely to benefit from treatment with fecal transfaunation.

I treat patients that have pathogens with an appropriate course of antibiotics to decrease the numbers of the pathogen until 48 hours before the transplant, however I have no evidence that this is necessary.

Donor Selection

Donors should be well screened, retrovirus negative cats that have been regularly dewormed and that have been screened by PCR for GI pathogens. They should have a history that is free of any major gastrointestinal disturbances and have had minimal to no antibiotic use to insure the best diversity of normal intestinal flora.

Donor and recipient cats should be eating similar diets for the best chances of success as dietary effects on intestinal flora may be significant. If recipient cats have food allergies, it is important to select a donor that is not eating a diet that contains allergens that might affect the recipient. Blood donor cats are often good choices.

Equipment

The equipment needed to perform a fecal transplant is minimal and most clinics will already have what is needed.

Method

Sample preparation:

Feces should be collected as close to the time needed as possible. We use voided feces whenever possible, but if unavailable, a sample can be collected by manual evacuation from the donor. If an incubator is available, feces can be collected with litter removed then put in the incubator with a small amount of saline to hold until use.

Investigational studies have published dose guidelines, however, I haven’t found these to be terribly helpful. Feces vary a great deal in water content and fiber content, so I have settled on volume and texture as guides in my practice. I use the entirety of a normally voided bowel movement to work with. Total sample is determined by how much sample there is and what volume is appropriate for the size of the cat’s colon to comfortably hold. Approximately 40 to 60 ml is usually appropriate for a 10 pound cat.

Once the patient receiving the transfaunation is in the hospital and ready for anesthesia, the sample is

prepared.

The fastest and easiest way to prepare the sample is to measure 10 ml of warm saline into a syringe and add it to a bowl with the feces. Care should be taken to not add too much saline, so if the sample is small or wet, use less saline. Safety equipment including gloves, face mask and eye protection is recommended for these steps to reduce smell exposure and prevent accidental exposure to bacteria.

Once the sample is the consistency of paste, clumps of hair can start to be removed. The sample should be thinned only the minimum amount needed in order to be able to force it through the catheter. If it is thinned more, it will not be retained as well.

It is quite amazing how much hair can be present in feces. It is not unusual for a sample to be reduced by as much as 1/3 through removal of hair. It is not necessary to remove all hair, just enough to make it possible to force the slurry through the syringe and catheter.

Once the transplant sample is loaded into the syringe, the outside of the syringe can be cleaned with water and the catheter attached.

At this point, the recipient cat is heavily sedated or anesthetized. The recipient’s colon should be evacuated. If the cat has a history of pathogenic diarrhea, it is a good idea to rinse the colon by placing warm saline as high into the colon as possible and then suctioning or manually evacuating it. If this is done, be sure to remove as much fluid as possible.

Once the patient’s colon is prepared, the pelvic area is elevated by about 1 to 2 inches to allow gravity to help retain the transplant sample in the colon. The lubricated catheter attached to the filled syringe is introduced into the colon through the anus and advanced gently as far proximally as possible, at least to the level of the transverse colon, and the sample is slowly pushed into the colon. If the colon is flaccid, it can be helpful to gently hold around the colon as this is done, partially occluding the lumen to keep as much of the sample in the transverse colon as possible as it is instilled. It is important to give the colon time to expand as the sample is placed.

The catheter is slowly removed, holding the anus closed around the catheter to prevent leaking. The anus is held closed for at least 1 minute as the colon adjusts to having the sample in its lumen.

The cat remains with the hind quarters elevated as it begins to recover from anesthesia.

It is important to avoid providing the cat with a litter box for at least an hour to aid in retention of the sample. Early evacuation of the sample can result in failure of the transplant.

Success/Failure

As mentioned previously, success is more assured in younger cats with shorter duration of diarrhea or dysbiosis. About 1/3 of the cats we have performed this procedure for have needed a second dose 2 to 6 weeks after the first. One shelter patient needed 3 doses before she had permanent resolution of her diarrhea. It would not hurt to simply assume that 2 doses will be more successful and just make that the protocol, however, I have only given further doses if diarrhea or dysbiosis reoccurs. Almost all cats that have a return of signs that benefit from further doses will have days to weeks without diarrhea after the first procedure. If there is no improvement within 2 weeks after transplant, I have found that it is unlikely that the cat will benefit from further fecal transplant.

Fecal transplant is, overall, a low risk and inexpensive treatment for diarrhea that we have found to be both practical and effective in our practice. It has been particularly attractive for cats in shelters that have chronic diarrhea, possibly due both to the increased likelihood of antibiotic use and infectious causes of diarrhea in shelters and the inexpensive nature of the procedure. Even in shelter cases where there are no funds for doing a pre-transplant work up, the success rate has been good in our experience. There, of course, may be wide variation in success rates in different regions of the world, depending on the common causes of diarrhea and differences in diets and normal flora, but so far, it has been successful in our practice.

RE: Faecal transplant for cats

Kate Richardson — Thu, 14 May 2020 10:00:54 GMT

Other things to consider/try-

did you run pcrs for any other infectious agents incl viruses? Have had a few kittens positive for coronavirus which just took time.

Could still be tritrich- talk to lab about more specific tests or repeat PCR?

Some people have reported success with chronic IBD cases using a highly concentrated probiotic called VSL#3- worth a try.

Gut biopsies?

RE: Faecal transplant for cats

Anthony Todd — Wed, 13 May 2020 09:40:00 GMT

Boiled fish, or have you already mentioned that?

As anyone else ever had a cat with this sort of history? I never have.

RE: Faecal transplant for cats

Joyce Whitehead — Wed, 13 May 2020 07:57:16 GMT

No not fed by anyone else, was in a cage with us for 2 weeks and we tried chicken to no effect as I’ve said.

RE: Faecal transplant for cats

Anthony Todd — Tue, 12 May 2020 22:48:03 GMT

Sounds as if water only [and in a cage] then boiled chicken and/or boiled fish only, may end up being tried, as other options don't seem to be the answer.....!

Is the Whiskas single protein with near zero fat [the website is rather vague.]

After all, even if it goes against the grain, there aren't too many options left.

I don't suppose the cat is being fed elsewhere or by another family member as has happened occasionally in my difficult cases??

PS and kept indoors!?

RE: Faecal transplant for cats

Joyce Whitehead — Tue, 12 May 2020 22:05:04 GMT

Hi Jennifer, we did try probiotics but no effect. I spoke to the owner today and he is a bit worse the last 48 hours so I’m not sure if we are still winning. We have tried a variety of very limited (including hypoallergenic) to no effect. He is currently on whiskas, and was not too bad at the end of last week but has gone a bit backwards again. So we may try yet another food, he is still having B12 too and is coming for a check up at the end of the week.

RE: Faecal transplant for cats

Jennifer Whybrow — Tue, 12 May 2020 21:14:22 GMT

Hows the cat now?

Am not sure if this helpful but i took on a cat that had been fed whiskas fine but. cat hd diarrhoea with me so phoned back practice where he had had the whiskas and discovered that it was different whiskas. Phoned whiskas to discuss, Turned out one i had fed had wheat in, the other didnt. challenge confirmed it. Was wheat. Hes 9 and can now tolerate occasional wheat eg munchies that i only bought to get the toy.

Not saying its that but what worked for him was kaolin, charcoal, you can get human stuffi n holland and barret, little capsules that you can open and then find powder inside, the 24 hrs starve first of course. then he went onto royal canin kitten pink bag of dried stuff.

Been pretty much fine since

The charcoal powder works well for the stinky flatulences but it is inclined to make everything black. I find butchers food pretty good (no wheat) its wheat too not gluten - porridge is fine.

So some whiskas is wheat free. the gravy one had wheat.

did you try probiotics before the fecal trnasplant as woudl be interesting to know if that is superior?

[quote userid="7269" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29059/faecal-transplant-for-cats/222385"]Now on whiskas, as I’ve said before (twice) Anthony, we have tried restricted diets to no effect[/quote]