Diarrhea doesn't stop

[Ash]

Day 4 of the antibiotica and the first time today since 18 days that her stool was partially formed! She will get 3 more days of the antibiotica.

She eats well again and seems very normal otherwise. So I think she is on the mend.

Thank you again, Traci, for your suggestions and advice!

[Traci]

Good to hear, but if this occurs again, soon, you'll want your vet to test the stool for additional bacteria (culture).

[Ash]

Hi Traci!

So she was fine, her stool on Wednesday looked completely normal, but two days after the antibiotic course was finished she started vomiting again (once a day) and the stool is once more mushy and watery (2-3 times a day). (but no blood or mucus in it) She eats and drinks normally though and is active and acts normal.

So the vet wants us to bring her in tomorrow (Monday) morning and wants to take blood: CBC, liver and kidney values.

My questions to you are:

are there any additional blood values we should test her for?

should she be x rayed?

which other bacteria should the stool be tested for apart from the five we did already?

Could there be another disease behind all this apart from salmonella and e coli which was found in the stool last week? Since both times when she got antibiotica there was an initial improvement wouldn't that mean that the infection is the only disease?

I'm worried ... I hope it's nothing more serious ... [/b]

[Traci]

You may need to repeat a fecal exam because sometimes parasites aren't detected on one sample. So, a repeat fecal float or fecal smear to rule out parasites like giardia, coccidia, or other types of worms. The vet could also use part of the sample to culture again for e-coli or other bacteria, since you always want to re-culture after a course of treatment to ensure the bacteria has been eradicated or not.

The same as I mentioned before, as far as testing for: salmonella, e-coli, campylobacter, clostridium. Or maybe even testing for fungal disease.

I assume she has been tested for FELV/FIV before?

Are you certain she is not getting into something she isn't supposed to? Like plants, fertilizer, herbicides etc? This is one reason you should be keeping her indoors so she can't further ingest or be exposed to something from the garden or outdoors and so you can monitor what she eats, drinks, her behavior, her symptoms etc.

Even though the vet said he would test with CBC and liver and kidney enzymes, you want to make sure the latter is a complete blood chemistry profile, it includes liver and kidney values, but also other important values (such as endocrine, heart, pancreas, etc). Pancreatitis might also be of concern if the vomiting and diarrhea have not resolved. Usually, you'd see the cat is obviously depressed, has a painful abdomen, anorexia, vomiting and diarrhea, sometimes fever, and dehydration. But, if caught early on you might only see a few of the symptoms in the beginning and be able to treat it effectively so that other symptoms don't occur. The lipase and amylase (and even protein and liver values) are markers in the chemistry profile to pay attention to with pancreatitis, but the lipase and amylase are not specific enough to diagnose pancreatitis. The most accurate test is the fPLI, which, in the US, is sent to specialized veterinary labs (i.e., Texas A&M).

Given her age, I'd also strongly suggest thyroid testing (T3 and T4) as well as include a complete urinalysis. A urine culture might also show e-coli or other types of bacteria that could be colonizing somewhere. X-rays can be helpful to detect size of organs (like small kidneys), mass, or partial obstructions or inflammation somewhere.

As far as disease, yes of course, you want to rule out other factors. Those might include IBD, idiopathic colitis, toxoplasmosis, aspergillosis, histoplasmosis, bacterial overgrowth in the intestine, pancreatitis, diabetes, hyperthyroidism, viral disease and lymphoma.

I know it's all overwhelming, but start with baseline testing, such as a CBC, full chemical profile, thyroid testing, re-test fecals and/or cultures, x-rays, urinalysis, and even consider the diet, if it's too high in fat, or if you're giving her milk products, etc, she might not be able to digest these anymore due to age. The vet shouldn't be giving more antibiotics without re-testing fecals or testing for fungal disease or checking vital organ function and checking for other diseases I mentioned. He really needs to look at the CBC results carefully because I suspect her electrolytes are out of balance, most likely dehydrated and may need to be replenished through sub-q fluids. A lot of other things can be seen on the CBC as well, he has to pay attention to that.

[Ash]

Hi Traci!

Thanks for your reply. I'm not sure though all these tests are done here.

We tried to draw blood from her yesterday, wasn't successful as she is too freaked out (it's always been like that with her, she always needs to be sedated for blood taking). The vet didn't want to sedate her, for several reasons - because of her age, because she would need to fast before and would probably feel nauseous afterwards, and because of her already irregular eating pattern, he decided to go for another course of antibiotics, this time injected.

But if this doesn't improve her we will sedate her and do the blood tests.

She has never been tested for FELV/FIV, not sure if it's done here, or even if the disease exists here. My vet never mentioned it.

He did mention pancreatitis as a possibility. As I said if this course of antibiotics doesn't work we will test for it.

It's like this at the moment: for a couple of days she seems to be fine, stool is normal, and then diarrhea (mushy) starts again. Today there was a drop of fresh blood on top of the stool. But she eats normal, drinks normal as far as I can tell, and is active, so that at least is a good sign. She vomits sometimes, but not a lot. Sometimes it's only white foam, sometimes it's food she just ate. She has a low grade fever (just on the borderline, the vet said).

She doesn't get milk. We don't use any fertilisers, and when she's out she doesn't roam. Anyway the garden is small, she usually goes out and sits on the bench, watching birds etc. She has always been a quiet cat, just sitting, watching a lot. So I really don't think she picks anything up in the garden.

I have a feeling that she is not agreeing with the Whiskas anymore, which she has been eating for about a year now. When she didn't want to eat last week we boiled chicken filet pieces for her, and that seemed to be more agreeable. The Whiskas comes back out more often. So we have bought the other cat food again which she used to get in the past ("Chow Cat"), lets see how that sits with her.

It's quite frustrating ... my vet wants to "wait and see" most of the time, and I have to come and say "let's test for this, let's test for that ..." And just to clarify: vets don't do any tests themselves, they don't culture stool or urine or anything. This is all done in the lab. Here, vets don't have ANY diagnostic equipment. They work in a small, dirty room with a table and a cupboard, that's it. Just so you get an idea how rudimental it all is ...

Having said all that, he did help my animals well in the past. Tommy was very ill last winter, and my dog has an enlarged heart, and he helped the streetdogs many times .... so it's not all bad. Ofen I didn't even feel the need to ask you because he handled it very well himself. But this with Noodle I find it disappointing ...

Anyway, I'll keep you posted! Thanks again!

[Traci]

Have you ever considered moving to the US? Your pets would certainly fare better!

The problem with the antibiotic approach is that if he doesn't identify the bacteria properly, he can't assume choosing this or that antibiotic is going to target a specific bacteria. There are hundreds of types of bacteria but only a few types of antibiotics that will target some of the most specific bacteria.

This is why additional testing and cultures are imperative. The low-grade fever is concerning, there is either an infection going on somewhere that is not being identified and treated properly, and/or there is a possible virus undetected, and/or there is a primary health condition developing.

I'd be concerned about sedating her for the sole purpose of a blood draw. Can you assist when he does a blood draw? Do you know how to gently restrain a cat in a fixed position so she can't wiggle, or scratch? Can your hubby come along and help you?

I'd get a full chemical profile and CBC done anyway, as mentioned before, the CBC is a good method of determining if this might be bacterial vs viral, and the chemical profile shows alot about vital organ function.

[Ash]

Vets usually don't have any assistants here to help treating animals. That's all done by the owners (except in surgery when he gets a second vet in). We held her with two people, I and my husband, and still she wriggles and gets very very stressed out, screams etc.

It's the middle of the night and I'm a bit worried because since the injection today she is a bit weird ... a bit weak. I called the vet he said it's ok, I should call him if it gets worse in any way, if she's wobbly on her legs or something (but she isn't).

So I can't sleep because I worry. She is sleeping now.

PS: we would all fare better in the West, but not enough money to move, with four pets as well ... )

[Traci]

Do you know what the injection was? Name of the injectable antibiotic?

It could be because the injection was painful and she is stressed. Watch for any signs of lethargy, fever activity, refusal to eat or drink or move about/activity, drooling at the mouth, dilated pupils, pale mucous membranes in the mouth (gums)....in which, you'd want to get her back to the vet immediately for treatment for an injection reaction. (usually, IV fluids, a veterinary fever reducer if there is a high fever, and anti-nausea meds if vomiting etc.)

[Ash]

I think it was cefotaxime, but I don't know how much he gave. He did weigh her first (4kg) and looked the dosage up in a book or something. He said he also injected something to stop the diarrhea, but I don't know what that was.

She does have slightly dilated pupils and I mentioned it to the vet when I called him. He asked me to shine a torch in her eyes and the pupils contracted a little when I did that. He said it's alright.

She just woke up and wanted food. I offered her the Chow Cat but she didn't want that, she wanted the Whiskas. She ate a couple of pieces and they came back out just half a minute later. I definitely think the Whiskas is not good for her at all at the moment, because earlier she had a little Chow Cat and also about a quarter of a boiled egg yolk and all that stayed in. She also drank water.

Could the Whiskas be at the center of this whole problem? I think I will stop it entirely now and limit the amount of dry food altogether. Boiled chicken and boiled egg seem to be easier for her at the moment. Maybe the vet could give her a vitamin injection so that she isn't lacking anything?

[Ash]

She is now cleaning herself. I got on her nerves inspecting her gums I think she's alright.