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Hello again.

My general recommendations would be:

1. An isotonic, oligomeric, fat-restricted liquid diet can be fed initially, with a gradual transition first to a polymeric liquid diet and then to an easily assimilated, fat- and fiber-restricted diet. I have recently been discussing with Hills their new microbiome diet. I wonder if this might be a good option here?

2. Malabsorption of fat- and water-soluble vitamins and minerals also can occur, and dietary or parenteral supplementation could be required. Parenteral cobalamin supplementation is essential if the ileum has been resected. I would consider Cobalaplex (Protexin). I think this is a good option as there is a probiotic as well as folate too.

3. Proton pump inhibitors can be used in the postoperative period to counteract possible hypergastrinemia.

4. Antimicrobial agents can be necessary if the ileocecocolic junction has been resected or if secondary SIBO is suspected. If metronidazole has not been helpful I would consider tylosin at 10mg/kg TID. This comes in powder form and has to be made up in gelatin capsules (which is obviously a massive pain). The alternative is to get the re-formulated tablets from Summit Medical.

5. If the response to diet and antibiotics is poor, antisecretory agents (loperamide, diphenoxylate, or octreotide) could be required. Bile salt binding resin (e.g., cholestyramine) might help reduce colonic secretion caused by bile salts malabsorbed after ileal resection; ursodeoxycholic acid has been shown to enhance intestinal adaptation in a feline surgical model.

Hope that helps.

Scott 🙂

Hello.

So sorry for delay! Can I ask a couple of further questions?

1. Any improvement with consistency with the addition of metronidazole?
2. Would you mind sharing the details of the histopathology?
3. How much intestine in total do you think you removed?

Scott x

Hey.

I think it is almost impossible that it could be the Cobalaplex (which I think it is a good idea by the way!).

Could it be a build up effect of using the Aktivait? Problem with that theory would be that you would have to take him off it too see. It could also be doing him a lot of good and we would not want to risk making him worse in other ways.

I suppose it could also just be an ageing change in itself?

Scott x

You are right. It is definitely a thing and quite well recognised now.

Let me know how the treatment goes.

I found another useful review:

https://pubmed.ncbi.nlm.nih.gov/22720812/?from_term=feline+cognative+dysfunction&from_pos=1&from_exact_term=feline+cognitive+dysfunction

Scott 🙂

Amazing answer Simon. Could not have said it better myself!

Let me know if you have any other questions.

Scott 🙂

So… based on the clinical presentation my neurology specialist pal made the following comment:

“Although cerebellum is compatible with some of the current clinical signs, the fact that he also was unresponsive and no proprioception may indicate that the brainstem is also affected. Either way, I agree with you that intracranial seems the most likely. As you said, ischaemic encephalopathy and neoplasia sound like the most likely differential diagnosis… There may be a potato arising/compressing the caudal fossa (brainstem +/- cerebellum)”.

I will follow up at the clinic and see if I can get more information about the actual case outcome.

Hope that helps.

Scott x