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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 38904
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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I am really worried about my 11 yo british blue cat Dolly.

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Good morning. I am really worried about my 11 yo british blue cat Dolly. For 6 months she has had chronic diarrheoa. It started suddenly, literally ovenight and hasnt stopped since. I went to the vet in the first few days and she was given a 5 day steroid shot. Im not really sure it worked because at that time she would do the odd normal poo, some half formed half runny and some runny. We had a selection of these during that week. After 10 days I referred to a oncology specialist who performed in depth tests including urineanalysis stool test GI panel bp and ultrasound. These tests all came back normal except the bloods which showed a slightly lower folate and low neutrophils. Colbalamin was normal and all kidney values were too exceot slightly raised BUN. This is always the case as Dolly is extremely nervous at visits or indeed most of the time. I have tried extensive natural therapies such as pro biotic SEB bentonite clay peridale fibre caps. Initially the peridale helped but now no real improvement. She passes 4 or 5 soft barely formed stool per day that smell awful. She strains a lot as if she feels incomplete emptying. Otherwise she seems well in herself. Sometimes I think her belly gets sore, Im not sure for certain but this is what i see in her body language. Then she will be fine eating drinking and playful, We didnt do a biopsy as my specialist thought it was not the right thing for an otherwise healthy cat with a normal ultrasound. I took my cat back to my regular vet on Tuesday to ask about next steps. We started her on 5mg prednisolone 2 x daiky for 3 days then 5mg once daily for 5 days then every other day then review. She has now had 3 tablets with no change in bowel habits. No improvement at all in her stool consistency. I am at my wits end with how to help her. I have feared it was lymphoma from the first day. The vets have assumed IBS until something else shows up but I asked about retesting and biopsy and my vet seemed to think there was a greater risk than was worth taking. I would really like a follow up ultrasound now to see if anything comes to light and repeat bloods. My question is what does it mean if prednisolone doesnt help? I was under the impression pred was useful for both IBS and Lymphoma. I have spoken to many people with experience of these diseases and it seems pred always at least improved the symptoms a little in the beginning. If the pred doesnt work how long will it take before I can stop it? I dont really want the drug in her system any longer than it needs to be if its not helping. She was loosely diagnosed with CKD after one blood test. This was about nine months ago when she had an acute episode of vomiting and watery diarrheoa and inappetance. I asked for bloods and kidney values came back slightly raised with an SDMA of 17, previous SDMA was 11. Creatinine was also raised a little. Its possible she was a little dehydrated that day as had been vomiting fluid and not eating for 48 hrs. When I repeated bloods SDMA was back to 11 and creatinine back to normal value with a negative proteinuria. So we suspended the CKD diagnosis. Dolly has had lots of steroid and antibiotic treatments in last 2 years. She had mouth inflammation with a bad tooth and inflammatory mass removed 2 years ago. Then an anal sac abscess. Then she had a fall and broke her tail. She had some cystitis from stress as she is very nervous and all the vet visits cause her a lot of stress. She was doing really well when she started with the diarrheoa. I am at a loss of what to do next. It seems crazy that there is nothing to help with her diarrheoa.

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Jessica, I'm sorry that your question wasn't answered in a timely manner. Thank you for the thorough history you provided. I don't see anything left to do but scope and biopsy Dolly's GI tract which isn't done soon enough in too many of these patients. To answer you directly, if prednisolone isn't helpful it's unlikely that IBD is present but I can't rule out that a higher dose of prednisolone might be effective or adding the immunomodulary antibiotic metronidazole to the previous dose of prednisolone might be effective. When prednisolone is discontinued after chronic use, it's best to taper the dose over a period of 3 weeks. Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
Hi Dr Salkin and thank you. I did have an ultrasound done 6 months ago but the dr at that time advised against biopsy. When I consulted with my vet this week and commenced treatment he warned against the risks of biopsy. It seemed he was trying to deter me somewhat as he said only a full thickness biopsy would be reliable and that 25% of these surgeries breakdown ending in disaster for the cat. Obviously this is very worrying for me to consider doing to her. In your opinion would a scope be adequate? I am going back next week and will ask for a referral to an internist. I think this will give us the best outcome. I am not sure if there are any in my area though. Since being on the pred Dolly is obviously not feeling too good. She is more lethargic and a little aggressive so Im guessing the pred doesnt make her feel too good. I did enquire about budesonide but I believe its not licenced for cats over here so cannot be prescribed. Do you think it is worth trying B12 injections? Also should I consider stopping the prednisolone if we are going to biopsy? How long do they need to be off before biopsy? Thank you for responding. I am so worried about having an open surgery done as I am not sure how much it will change the outcome. Should we find lymphoma the only option then would be chemo and I doubt very much if she will do well on that as she seems very sensitive to any medications. Jess

I believe that scoping is not only adequate but the next reasonable step in my patient suffering from 6 months of diarrhea. I'm not sure why you've been dissuaded from considering scoping. Yes, full thickness biopsies are preferable and I've performed numerous full thickness biopsies during exploratory surgery without experiencing breakdown at the surgical site. Yes, an internist ( medicine) is smart and unless a repeat ultrasound is definitive, scoping and biopsy will be recommended. Vitamin B12 is palliative therapy for malabsorptive syndromes. It doesn't address the case of the malabsorption. Yes, tapering off prednisolone is best prior to biopsy but historically hasn't been found to alter the biopsy results. It will, however, help prevent tissue break down at the biopsy site. The specialist will advise as to the timing of the taper. Please continue our conversation if you wish, Jess.

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