Diarrhea doesn't stop

[Ash]

Hi Traci!

I have to ask you again for advice.

My cat Noodle has had diarrhea for the past 11 days. At first it was bloody and had mucus, she had a fever of 104, and wasn't eating. The vet gave her Norflox TZ (= Norfloxacin + Tinidazole + Lactic Acid, she got 100mg Norfloxacin twice a day) for 5 days. She improved immediately, her appetite came back and her temperature dropped to 101. But the diarrhea didn't stop although it's not bloody anymore and has no mucus, just brown. She has stool about twice a day and a lot of gas.

On the last day of the antibiotic course she vomited 3 hairballs out, could that have something to do with it? The vet seems to think not.

She finished the antibiotica last Tuesday. Since she still had the runs I called the vet and he said we watch it for 3 days. As the stool didn't improve we went back with her to the vet yesterday, he checked the temperature = normal (101), and felt her belly. It is soft and he didn't find anything unusual.

He doesn't think she still has an infection but thinks her intestines are simply irritated. I was worried about chlostridium dificile, but he said she would look more sick and have a fever if it was that.

I suggested a stool test, but he said it won't tell us much. We could check for worms though. So today I took a stool sample to the lab to do a full analysis plus check for worms. I asked the lab doctor about chlostridium dificile and he will test for that too, but that particular test takes 4-5 days.

The vet gave me a product called DiaDog'n CAT yesterday to give her for two days.

Quote from a supplier website:

"DiaDog'n CAT contains a complex composition of natural extracts to treat diarrhoea, regulate unsettled intestinal absorption and restore the natural balance.

Chewable tablets for single administration or mix with feed, for animals with acute diarrhoea and recovering.

Composition:
Fruit residue,
Glucose,
Sodium chloride,
Potassium chloride,
Vegetable ancillary products,
Sodium citrate,

Additives per kg:
Bentonit-Montmorillonite - 40.000 mg
Betain - 4.000 mg

So far it has not improved the stool (she had the tablet last night and this morning).

So what else can we do? She doesn't look sick, she eats and drinks, she grooms herself, walks around and watched the birds in the garden etc. Pretty normal. The only thing she doesn't like at the moment is play with Tommy. Like she is a bit low energy. She is not dehydrated either.

Anything else we should do now?

Thanks Traci for your thoughts!

[Ash]

Btw, Noodle is 10 years old now.

[Traci]

What are you feeding her, and have you recently changed her diet?

Test the stool, meaning a CULTURE, for salmonella, toxoplasmosis, e-coli or campylobacter.

Stop using the "DiaDog'n Cat" stuff and ask your vet for Flagyl (metronidazole) instead.

If you can get prescription diets there, ask about a temporary diet of Hill's Rx kitty I/D, dry or canned, and feed a few times a day, in small amounts. Any of the veterinary prescription diets that are designed for gastrointestinal health would be ideal, on a temp basis, then when the diarrhea resolves, slowly graduate her back onto her regular food, unless it's the culprit in which case you'd want to re-evaluate her diet.

Don't assume she's not dehydrated, with severe and prolonged diarrhea (and vomiting), she's more than likely dehydrated. Make sure you have several water bowls around the house.

If she's not allowed outdoors, she probably doesn't have worms and would probably not need deworming. If she IS allowed outdoors however, start keeping her indoors only so you can monitor what she eats, her routine, how much water she drinks etc. Remember that outside stagnant water sources are full of bacteria (like gardia for example).

If the Flagyl doesn't give relief and resolve in a few days, you might want to consider full bloodwork, a CBC, and xrays to rule out IBD, and dietary change to a veterinary diet geared for GI health.

[Ash]

Thank you Traci!

I will ask my vet for Flagyl tomorrow.

We have a small garden with a cat fence. Sometimes she does indeed drink rain water there - I assume that's how she got the current problem. But shouldn't the Norfloxacin + Tinidazole which she got for 5 days have resolved the problem?

I will ask the lab what they are testing the sample we brought in today for. I told them to do the routine analysis plus look for worms/worm eggs, parasites and chlostridium dificile. If what you suggest is not included we'll bring another sample.

Since you don't mention chlostridium dificile, can I assume you think it's unlikely?

My vet said, there is always bacteria in stool, so a stool analysis doesn't really help much. Do you agree with that? I was a bit confused by his statement.

No, we have not changed the food recently and we don't get prescription diets for cats here at all, absolutely nothing (import restrictions). At the moment we only get Whiskas and Show Cat by Venky's Pet. Noodle prefers the Whiskas. We don't get ANY higher quality foods for cats.

There are 3 water bowls around the house, and she vomited only twice in 11 days. I did the skin test in her neck, I don't think she's dehydrated but will ask the vet to check again.

What is IBD?

[Traci]

I'm not familiar with the Norflox your vet used, but if past posts are any indication of his competence, you can never be sure he's using a med approved and useful for cats, or the correct dosage. Flagyl on the other hand, is almost always successful.

Clostridium is more common in dogs than cats. The parasites/bacteria I posted above is what you should be looking for.

The comment about stool samples not being helpful because "there is always bacteria in the stool", is I presume, par for the course to him. Since you can only effectively treat bacteria you properly identify in the first place, I'm not surprised he doesn't know how or what to use to treat. You have to first IDENTIFY the type of bacteria in some way (fecal float, smear or culture) in order to choose the most EFFECTIVE treatment. It is never a one-size-fits-all approach.

IBD is Inflammatory Bowel Disease, a somewhat common affliction in older cats, and can also occur secondary to any other primary health condition in an older cat. It is inflammation of the intestinal tract, intolerance of certain ingredients in the diet, can cause either/or constipation or diarrhea and is usually treated with proper diet (i.e., hypoallergenic diet specific), sometimes the use of lactulose or cisapride, sometimes the use of steroid therapy to reduce inflammation. Treatment is individualized to the patient's needs.

[Ash]

We have used Norflox in the past, I think it's quite commonly given here. Stool cultures are however not commonly done here, only if treatment is not giving good results.

I feel bad that I did not insist on doing a stool test and culture earlier. And at first she improved well while on Norflox so I didn't think it neccessary anymore.

So should I cancel the clostridium test with the lab? It's expensive and if you think it's unlikely ... ??

[Traci]

Is he competent enough to run a stool culture and know how to identify certain bacteria? It doesn't sound like he knows???

If you don't think he's competent, then just ask for the Flagyl.

I hope you understand I hate giving such advice since you're in another "world", and I have no clue if your vet knows what he's doing.

[Ash]

My vet and the lab doctor are two different people. The lab guy just does what I tell him and I think he's competent to do the tests.

My vet did not advice to test for clostridium, hence I asked your opinion.

[Ash]

Hi Traci!

So, we got the stool test results. The routine examination showed pus and blood in the stool. No worms or worm eggs but the culture showed e coli shigella infection. So starting today she gets another antibiotic (ofloxacin) plus ornidazole. There are still test results for the other organisms outstanding, but we didn't want to delay treatment any longer.

She is unchanged. Watery diarrhea, sometimes a little blood in it (which looks fresh, maybe her anus is sore by now), sometimes she vomits (not every day though). She drinks well but isn't eating too well. No fever.

Lets' hope this tablet will help!

I'll let you know!

[Ash]

Btw, metronidazole isn't available, hence she gets ornidazole.