Help with possible IBD

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Margarida

Margarida

Member Since 2020
Hello! My name is Margarida and I'm a new member. I'm her to find help for my almost 5 years old Nikita.
She was diagnosed with CKD last August but since her medical issues started when she was around 18 months old: idiopatic pancreatitis, colitis, overgrooming and subsquent hairballs, etc. I did my best to have them all adressed, but one thing that was always in the air was stomach upset, inflamation and obstipation.

She is on Enalapril so that kidneys receive more blood and she is eating renal diet (Hills K/D kibble and Royal Canin Renal Wet pouches/ Kattovit Renal pouches/Purina Pro Plan Renal NF RX morsels - it varies accordingly her willing).

My original thread is here: http://www.felinediabetes.com/FDMB/threads/new-member-nikita-puzzled-and-lost-tutor.231668/

Now, the update from 3 days ago (Wednesday):
"Update on Nikita:

Today at the vet an abdominal x-ray was done since due to gas the ecography was not showing more than already did.
With the x-ray the vet found impacted stools across all intestine! Also evidence for gastritis.
The vet , due all Nikita history, is more inclined for IBD then pancreatitis.
He gave Nikita 5ml of rectal lactulose to see if the stools would come out on their own. She will still getting 1ml twice a day of lactulose and, if needed 5ml of rectal per day. He also advised to keep the Enalapril since it allows the kidney to receive more blood and work more effortlessly. Also, 1/4 of Cerenia 24mg for more 4 days.

When we arrived home Nikita went straight to the litter and was able to evacuate
She also ate a bit of wet and, now that I arrived from work, I know that she licked a bit more of wet and nibbled on her Hills K/D. She seems a bit less lethargic but she is still weak. At least she came meet me at the door ♥️

I've discussed further bloodwork, fluids and B12.
The vet didn't want to stress her more and, by the x-ray evidences, he states that we should watch for 24h more and only then decide for more blood drawing. As for the fluids no signs of dehydration*, so no IV for now as well. As for the B12, since there are no neurological issues, he does not see the need for it but he is open to give it within a few days if her gastritis, and mostly overall condition, won't improve. We will try to get more clues on IBD (by all her medical history since ever, her eating habits/etc). We will also keep an eye on glucose. As for cetosis, the vet says her breath is mainky caused because she was not eating/drinking and the obstipation reached the stomach (my poor baby).

What are your thoughts regarding this? Is there anything particular I should be paying attention to?

(*The white coating on her tongue and the dry nose could've been caused by her impacted feeces and gastritis. And since she was not eating/drinking this also concurred for it. When pinching her scruff the skin goes back in place quicly and her gums don't get white after pressing.)

I'm so grateful for finding this message board and all the caring people on it. Thank you all for being here with me on this cloudy days ♥️♥️♥️"

On Thursday she hasn't pooped, took her Enalapril with a tad of syringe fed wet food.
During the day she bate close to nothing
and vomited her Cerenia 30min after taking it at night.She was more alert, but she is still loosing wheight (obviously). She was given rectal lactulose and was syringe feed again at night (not much, but I just needed to get something on her stomach).
Vet told I could try to give her a senior food just to see if she eats. I'm working 7AM until 11PM, so I only bem able to get new food on Sunday :'-(.

Yesterday (Friday): Syringe fed pate in the AM. She nibbled on her snack ball a little after taking Enalapril. Had a bowel movement.
During the day she tried to eat but wasn't able to, like she had nausea (I was at work, it's my Mother feedback). She drank water.
I syringe fed at night (once again not much), she took her Cerenia but still not eating.

Today (Saturday) she asked for some oat grass (she was a heavy nibbler of her grass before this week, I think it has something to do with her belly and not so much with hairballs now that I think about it). Since she does not eat (but seems to be hungry) I syringe fed pate again. She is now sleeping on my lap and I will give her Enalapril within a moment.
Her energy is obviously low. Tomorrow (if not sooner) we'll go to the vet again.

I know this is a long post, but I really need some advice on this.
Since she has kidney disease and possible IBD/gastritis what can I feed her to get her eating?
I insisted on B12 but vet was not willing to at this point. Tomorrow I will insist again on the B12, see if Cerenia helped with inflamation but will ask for something else regarding nausea and appetite.

If you read it all, thank you so much!
Her bloodwork is posted on the original thread.
 
Usually with IBD, you want to be feeding your cat novel proteins. One of my cats was diagnosed with IBD. (FYI - the only way to have a confirmed diagnosis is with a biopsy. It's really the only way to differentiate IBD from lymphoma.) My cat was fed only canned chicken and turkey up until the time the IBD was diagnosed. He's now on a diet of raw pork and canned venison and lamb and rabbit. I also use only brands of cat food that contain no gums or carrageenan. I found this website on raw feeding for IBD cats to be helpful -- not just for the information on a raw diet but also for general information on IBD. They also have a Facebook page where they are great about answering questions.
 
Sienne and Gabby (GA) said:
Usually with IBD, you want to be feeding your cat novel proteins. One of my cats was diagnosed with IBD. (FYI - the only way to have a confirmed diagnosis is with a biopsy. It's really the only way to differentiate IBD from lymphoma.) My cat was fed only canned chicken and turkey up until the time the IBD was diagnosed. He's now on a diet of raw pork and canned venison and lamb and rabbit. I also use only brands of cat food that contain no gums or carrageenan. I found this website on raw feeding for IBD cats to be helpful -- not just for the information on a raw diet but also for general information on IBD. They also have a Facebook page where they are great about answering questions.
Click to expand...
Thank you so much for the guidance ♥️
Since Nikita had her 1st pancreatitis flare (she was about 18 months old and now she is almost 5 years old) that I tried to get her onto BARF and on Raw as well. Followed tips, recipes and clues from online forums and FB groups directed to BARF and Raw. I tried to go slow, offering it as a snack or reward, tried to entice using different combinations and textures, tried to mix with her usual food... She rather starve herself and even started to avoid food/meal time. I tried it several times, for weeks during all this time. But since she wasn't eating and getting thinner I always returned to her kibble and the few wet foods she tolerated.
Then CKD kicked in, she was doing fine with her renal diet and even started to enjoy her renal pouches more than She ever did for any other (she is not a big chomper, she never was except when she was a junior Kitty).
I am looking for a nível protein food with less than 250mg of phosphorus per 100g. But here in Portugal the stores are not very educated regarding nutrition and there aren't that many brands as well.
 
Bom dia Margarida,

Minnie has IBD and as Sienne said, it was only confirmed after an endoscopy and biopsy. Did your vet suggested that? A lot of vets advise to treat the cat as if it has IBD without the tests but I’m not sure that’s the best thing to do especially if she may have diabetes. Are you treating that yet btw? Are you planning on starting insulin soon? Since Nikita has other issues going on, I’m also not sure if the procedure would be okay for her right now. The treatment for IBD in addition to food is a localized steroid that is designed to work on the GI tract only called budesonide. Minnie is on it now and I can say it makes all the difference in the world. She eats like she did when she was younger now and is back to trying to inhaling her food and then going after Bono’s too! But I’m not sure how it would affect the pancreatitis and CKD. Maybe just bring it up with your vet and discuss it. B12 shots are a must for IBD and it has no side effects so I’m not sure why your vet is holding off on that. I get the B12 liquid and I do it at home. You don’t need to go to the vet for it as long as he gives you a prescription to buy it.

Boa sorte e bom domingo!
 
Hi,

Sienne asked me to stop by.


I'm in Spain. Same problems with pet food shops here.

I'm feeding George lower phosphorus foods. Keeping it below 1%. He has stage 2-3ckd. Based on bloods.

Finding low p diabetic food is tricky. Bit there are a few brands, you should be able to get on line.

Thrive shredded chicken
Thrive tuna flakes and thrive salmon and tuna are all below 1% P and low in carbs.

Terra Faelis is another brand, the chicken and catnip and turkey and squash have low P, George eats these but they are not his favourite. He prefers the thrive.

Also some of the granatapet symphony flavours are low in P. They have changed their recipes and though the used to around 3% carb they are now 8%. (We use the pure chicken and the chicken and salmon flavour)

Wild freedom lamb is also low in p, big favourite with George and the other cats.

Another low P is Ferringa, pure chicken with pumpkin and catnip.

I buy all these on line. Most I get from zooplus Spain, others from zooplus Germany (thrive and granatapet only now available from German site)

Terra Faelis I get from zooplus Germany too, but they only now carry one flavour. You can buy direct from Terra Faelis though.

Another food I recently discovered was the lily's kitchen supplies, I get those from huella canina in Spain, they may deliver to Portugal???

I'm on my phone at the moment, when I get home I'll post some links.

The UK food list on this site carries a list of foods. That are low carb, an you will also have the P values for the suggestions I've made above.
 
Aleluia Grugru & Minnie said:
Bom dia Margarida,

Minnie has IBD and as Sienne said, it was only confirmed after an endoscopy and biopsy. Did your vet suggested that? A lot of vets advise to treat the cat as if it has IBD without the tests but I’m not sure that’s the best thing to do especially if she may have diabetes. Are you treating that yet btw? Are you planning on starting insulin soon? Since Nikita has other issues going on, I’m also not sure if the procedure would be okay for her right now. The treatment for IBD in addition to food is a localized steroid that is designed to work on the GI tract only called budesonide. Minnie is on it now and I can say it makes all the difference in the world. She eats like she did when she was younger now and is back to trying to inhaling her food and then going after Bono’s too! But I’m not sure how it would affect the pancreatitis and CKD. Maybe just bring it up with your vet and discuss it. B12 shots are a must for IBD and it has no side effects so I’m not sure why your vet is holding off on that. I get the B12 liquid and I do it at home. You don’t need to go to the vet for it as long as he gives you a prescription to buy it.

Boa sorte e bom domingo!
Click to expand...

Boa tarde, Aleluia Grugu & Minnie

The vet wanted to go slow on this, since he is suspicious that all the scenario can be caused by kidneys and some kind of digestive/bowel issue.
We haven't started any diabetes protocol, he will run new bloodwork tomorrow to try to figure out the numbers and if the glucose levels changed.

Regarding IBD, besides the CKD Nikita also lost wheight (quite a bit!) and she isn't good for a biopsy...
I also don't know why he was so reluctant with B12, but I will ask for it tomorrow. Maybe it's because Nikita front paws veins are fibrous and he doesn't want to pinch her unless it's really necessary (when I talked to him regarding B12 it was for it to be given with subQ).

Also I want to discuss a phospate binder possibility since I tried a bit of Calibra Ultrapremium for Sensitive Cats (dry) and she is eating it here and there. The phosphorus on a dry matter basis is 1.09, but she has to eat and syringe feeding can cause food avoidance, it's better than nothing. And I'm willing to try "regular" but high quality foods (wet and dry, with moderate protein content).

Today she hasn't had any bowel movements and her pee seems a bit diluted (it's not plastering the litter, but it doesn't make the usual rounded balls, but tomorrow we'll know).
I will also ask if ondasetron and bruprophene could be an option.

Do you know the feeling of having options but not being able to have them? That's how I feel. Although I absolutely trust the vet and the team from the hospital, I feel that we could be a little bit ahead. It's like the rest of the world is 2 steps ahead and Portugal is 5 steps behind on medical care for pets.

Bom domingo para si e seus miaus, obrigada pela ajuda e carinho ♥️
 
Margarida said:
Boa tarde, Aleluia Grugu & Minnie

The vet wanted to go slow on this, since he is suspicious that all the scenario can be caused by kidneys and some kind of digestive/bowel issue.
We haven't started any diabetes protocol, he will run new bloodwork tomorrow to try to figure out the numbers and if the glucose levels changed.

Regarding IBD, besides the CKD Nikita also lost wheight (quite a bit!) and she isn't good for a biopsy...
I also don't know why he was so reluctant with B12, but I will ask for it tomorrow. Maybe it's because Nikita front paws veins are fibrous and he doesn't want to pinch her unless it's really necessary (when I talked to him regarding B12 it was for it to be given with subQ).

Also I want to discuss a phospate binder possibility since I tried a bit of Calibra Ultrapremium for Sensitive Cats (dry) and she is eating it here and there. The phosphorus on a dry matter basis is 1.09, but she has to eat and syringe feeding can cause food avoidance, it's better than nothing. And I'm willing to try "regular" but high quality foods (wet and dry, with moderate protein content).

Today she hasn't had any bowel movements and her pee seems a bit diluted (it's not plastering the litter, but it doesn't make the usual rounded balls, but tomorrow we'll know).
I will also ask if ondasetron and bruprophene could be an option.

Do you know the feeling of having options but not being able to have them? That's how I feel. Although I absolutely trust the vet and the team from the hospital, I feel that we could be a little bit ahead. It's like the rest of the world is 2 steps ahead and Portugal is 5 steps behind on medical care for pets.

Bom domingo para si e seus miaus, obrigada pela ajuda e carinho ♥️
Click to expand...

you don’t need to do the b12 via the vein. Like I said, you can do an injection like you would do for the insulin and you can do it yourself. It’s much easier for both you and her.

just to clarify the biopsy is not a surgery. It’s done via the endoscopy where they insert the camera down her throat and they can at the same time see and collect the biopsy sample.

it’s not just Portugal. Since I joined this forum I’m shocked at how many bad or just clueless vets are out there. I’m on the third vet for Minnie. The first 2 were incompetent to say the least :banghead::banghead::banghead:
 
Aleluia Grugru & Minnie said:
you don’t need to do the b12 via the vein. Like I said, you can do an injection like you would do for the insulin and you can do it yourself. It’s much easier for both you and her.

just to clarify the biopsy is not a surgery. It’s done via the endoscopy where they insert the camera down her throat and they can at the same time see and collect the biopsy sample.

it’s not just Portugal. Since I joined this forum I’m shocked at how many bad or just clueless vets are out there. I’m on the third vet for Minnie. The first 2 were incompetent to say the least :banghead::banghead::banghead:
Click to expand...

I thought that to get the B12 it would have to be through fluids ir by the vein. I will do mu best to get it since the more I read, the more it appears as fundamental to a wide range of diseases.
In order to do the biopsy She would have to be sedated and that's why they don't want to do it unless it's really necessary. I do believe my vet is trying to see if she can fight the inflamation with the least amount of stuff given or done to her (she is very anxious). But she is not improving and I just want to do what can be done.
The vet is very sought by people, the hospital has a great feedback and works closely with veterinarian universities and other specialists. And it is mindblowing how many are not aware how much treatments and options evolved.

Thank you for the support, Aleluia Grugru & Minnie (and all forum members)
 
Gill & George said:
Hi,

Sienne asked me to stop by.


I'm in Spain. Same problems with pet food shops here.

I'm feeding George lower phosphorus foods. Keeping it below 1%. He has stage 2-3ckd. Based on bloods.

Finding low p diabetic food is tricky. Bit there are a few brands, you should be able to get on line.

Thrive shredded chicken
Thrive tuna flakes and thrive salmon and tuna are all below 1% P and low in carbs.

Terra Faelis is another brand, the chicken and catnip and turkey and squash have low P, George eats these but they are not his favourite. He prefers the thrive.

Also some of the granatapet symphony flavours are low in P. They have changed their recipes and though the used to around 3% carb they are now 8%. (We use the pure chicken and the chicken and salmon flavour)

Wild freedom lamb is also low in p, big favourite with George and the other cats.

Another low P is Ferringa, pure chicken with pumpkin and catnip.

I buy all these on line. Most I get from zooplus Spain, others from zooplus Germany (thrive and granatapet only now available from German site)

Terra Faelis I get from zooplus Germany too, but they only now carry one flavour. You can buy direct from Terra Faelis though.

Another food I recently discovered was the lily's kitchen supplies, I get those from huella canina in Spain, they may deliver to Portugal???

I'm on my phone at the moment, when I get home I'll post some links.

The UK food list on this site carries a list of foods. That are low carb, an you will also have the P values for the suggestions I've made above.
Click to expand...

Hello Gill & George

For some reason I only was noticed for your post today. I do appreciate tremendously all the food advise!

I'm purchased at Zooplus.pt and Tiendanimal as well. About 2 years ago I tried to give her Granata Pet, Grau and Catz Finefood: she does not touch them
Nikita has hera appointment within 45min, and afterwards I will be updating her situation.
 
Just came from the vet. Nikita bloodwork will be done by an external lab since their equipment appears to be malfunctioning.
No urianalysis for now.
Nikita will on 15ml/day of Oralade Cat and Mirtazipine (1/3 of a 15mg tablet every 3 days - in Portugal 15mg is the lowest formula available). Wednesday will have the labs and we will see if she is eating on her own. We will investigate if there's an underlying IBD /thyroid (hipo or hyper)/diabetes issue caused by her CKD.
Lactulose will still be given, as well as her Enalapril.
If Nikita gets very sedated from Mirtazipine, the vet wants me to call in.

Right now I'm going to give her cuddles for being a good girl and later on will provide a more detailed update. But I want to thank to everybody for helping out, your guidance is truly much appreciated ♥️
 
Margarida said:
Just came from the vet. Nikita bloodwork will be done by an external lab since their equipment appears to be malfunctioning.
No urianalysis for now.
Nikita will on 15ml/day of Oralade Cat and Mirtazipine (1/3 of a 15mg tablet every 3 days - in Portugal 15mg is the lowest formula available). Wednesday will have the labs and we will see if she is eating on her own. We will investigate if there's an underlying IBD /thyroid (hipo or hyper)/diabetes issue caused by her CKD.
Lactulose will still be given, as well as her Enalapril.
If Nikita gets very sedated from Mirtazipine, the vet wants me to call in.

Right now I'm going to give her cuddles for being a good girl and later on will provide a more detailed update. But I want to thank to everybody for helping out, your guidance is truly much appreciated ♥️
Click to expand...
Awwwwwwwwww? please give Nikita some cuddles from us:bighug:
 
So, Nikita today has taken about 8ml of Oralade. She ate a little bit of dry food (the Calibra sensitive formula one, I can't get her to eat the k/d). We will start Mirtazipine tomorrow, but we'll go slow since I read that it can cause a bad reaction (not only vocalizing, but restlessness, agitation, etc). I'm thinking to get that oh so small tablet into 8 pieces so that the dosage is not so big: I want her happy and eating, not agitated and uncomfortable.

The vet says that we might try a phosphate binder to mix on non-renal food if she eats it better (watching for protein quality and amount, phosphate and other values). But only when she is over with Oralade Cat.
He also said that her kidneys will cause flares like these so the next step will be trying to figure out if there's already other correlated issues on the rise. She might develop IBD indeed. Her thyroid and sugar do need a deeper check.

Do you have any ideas for a safe Mirtazapine experience?

This time I felt that we were really a team working for Nikita. I don't know if what we are doing now will get her to eat and feel better. But I do know that without every single loving and educating post of each one of you I'd never find a starting path.
I'm still looking for your opinions and experiences, your knowledge. Because I love my sweet girl to bits and I'll do what I can for her. Here's a pic of her, on her "space shuttle" carrier, looking to what's going on outside the Hospital. These are the eyes and whiskers that fuel my days. This is why I thank you all ♥️
 

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I was able to cut the Mirtazapine into 16 small pieces* (for what I read the ideal dosage would be 1.875mg, being the efective minimum 0.5mg).
Approximately 30 minutes after the first hidden** dosis she started to eat by her own (the renal Hills, but I'll keep offering wet food since I know it's better for her).

*used a pill cutter to have it on half and quartes, then I used a new nail clipper to get the smaller pieces. The tablet is firm, the tools were sharp, so it didn't crumble like.

**Put the tiny dosage into half a Kattovit Renal morsel with a tweezer. Rolled the morsel without touching the pill and Nikita took it smoothly (pooped the little ball in her throat, just like a regular pill).
 
Hi Margarida,
I think you really need to try and get her on a low carb food. Diabetes is really hard on the kidneys, so if her blood glucose is high that in turn is going to compromise her kidneys. It is more important now to try and manage the diabetes as much as possible.
I know she is having problems with constipation, hence the lactulose, however, it is really sugary and sweet (I'm using it on a rescue dog I am fostering that has hepatic encephalopathy) and that is possibly not going to help with her blood glucose levels. Perhaps you could discuss a none sugar based alternative with you vet.
Folk here have used pureed pumpkin, miralax, and egg yolk to improve motility, additionally you want to try and keep her very well hydrated, I add water to all my boys wet food. With nikita's diabetes and CKD she is likely to always be slightly dehydrated as she her urine is likely quite diluted (especially as she insists on eating dry:rolleyes:), additionally with the weather heating up here on the peninsula, it's probably adding to her dehydration.

I recommend reading Dr Lisa's site for tips on transitioning to wet from dry and for info on feline nutrition in general (if you haven't already, but even if you have, take another look), she has PDF of info in various languages
http://catinfo.org/
https://www.felinediabetes.com/FDMB/threads/transitioning-your-cat-from-dry-to-wet-food.956/
And also there is a post she made on the board regarding dry food, I can't find it just now,:blackeye: but maybe someone will link it for you, I'll try find it.




Some cats are difficult to transition so in the meantime you may want to consider low carb dry, there isn't much choice here in Europe, you can try the ziwipeak or there is the dry from thrive.
I get the thrive dry from zooplus.de, it's not available on the spanish website, but they will deliver from germany to spain, and it doesn't take any longer. I use the dry for my non diabetic cats when they go to the cattery and also if I am going to be away overnight in the summer I leave it for snacks for George (he's in remission) in his auto feeder, he won't eat the wet if it's been sat out in the feeder too long, and if he doesn't eat it gives him acid tummy and he pukes. Other than that they all get wet. But it is a good quality dry with no crappy ingredients.

If Nikita likes real chicken and tuna, try their wet food, the chicken is just like shredded chicken and the tuna and salmon is just that tuna and salmon, if I put it on a salad for you you would not know it was cat food, perhaps she would find that palatable. George goes crazy for the Tuna and Salmon, he get's that once a week for his sunday breakfast. And it is low in P too.;) (also have to order form germany now since it is not stocked on the spanish site)


If you are having to assist feed, I agree it can cause food aversion. Just last week my civie/non diabeticFelix was very poorly and refusing to eat, so I had to assist feed, I used some food that is not his usual food (royal Canin Recovery in his case).

Whilst getting the P and carbs at the right levels, it is important that she eats, so you might just have to do what you have to do to achieve that. But try to not loose sight of the goals for her feeding regime, taking the steps you need to take to get there, with some cats you have to go slow.


We haven't got the values for P for the following dry foods, but at least they are below 10% carb, I would try and persevere with getting her on a wet diet as that will be a big help.

Thrive
PremiumPlus Chicken
(Dried chicken meat (64.5%), fresh chicken (16.5%), chicken fat (6%), sweet potato, potato, chicken gravy (3%), vitamins and minerals, salmon oil)
Widely available 9.4% carb
Grain-free. Contains sweet potato and
potato.

Thrive
PremiumPlus Chicken & Turkey
Dried chicken (52%), dried turkey (13%), freshly prepared chicken (13%), chicken fat (6%), potato, sweet potato, freshly prepared turkey (4%), chicken gravy (3%), minerals, vitamins, salmon oil
Widely available 8.7 % Carb
Grain-free. Contains sweet potato and
potato.



Link below has more info on the food.
https://docs.google.com/spreadsheets/u/1/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml


I read in a post of yours that you are familiar with Tanyas CKD site. I remember reading this back when George also got diagnosed with CKD, There's a lot of info on that site, it can be overwhelming, if you haven't already do go back and look at the sections that cover diabetic ckd cats. There a lot of useful information to be found.

I've cut and pasted from the section on Diabetes and CKD, and highlighted a couple of point that are particularly pertinent for Nikita

Diet for Cats with Diabetes and CKD

If you are dealing with both diabetes and CKD, it is more important that the diabetes should be regulated, and in fact once this is achieved, you may find the CKD improves too.

With diabetes, the focus is on carbohydrate control (see above). This is not a problem for CKD cats but people dealing with both diabetes and CKD are sometimes anxious because it appears that the protein requirements of the two conditions are incompatible. In fact reduced protein is not necessarily essential in the treatment of CKD in the early stages, see Nutritional Requirements for more information.

Even if your cat's CKD is more advanced,Keys to management of diabetes in cats(2011) Little S Presentation to the 36th World Small Animal Veterinary Association World Congress states "Current recommendations support the use of a high protein (> 30% DM), low carbohydrate (< 40% DM) diet for management of feline diabetes." A protein level of 28-35% DMA is often recommended for CKD cats so I would aim for a protein level of around 35% DMA for a cat with both conditions if your vet agrees.

2018 AAHA diabetes management guidelines for dogs and cats(2018) Behrend E, Holford A, Lathan P, Rucinsky R & Schulman R Journal of the American Animal Hospital 54(1) pp1-21 recommend a higher protein intake of over 40% on an ME basis. If your cat's CKD is early stage, this might be appropriate. The guidelines do state that they should be adjusted for cats who also have CKD, so for cats in IRIS stages 3 and 4, a protein intake of 35% might be more appropriate, so discuss with your vet.

The need to moderate phosphorus intake for CKD cats still applies to cats with both CKD and diabetes. Phosphorus levels are usually given in % DMA values for CKD cats (e.g. 0.5% phosphorus on a DMA basis), whereas phosphorus levels are sometimes given in mg per 100 calories for diabetic cats (e.g. 250mg/100 cals). Understandably, many people find it confusing trying to decide if a food is suitable for a cat with both CKD and diabetes. The simplest thing is to aim to feed a food with less than 10% carbs (ME) and as low a protein and phosphorus level (DMA) as your cat will eat. If necessary, add phosphorus binders.

One of Tanya's CKD Support Group members, April, has kindly created a short list of US cat food with less than 10% carbs (ME) and below 1% phosphorus (DMA). You can find the document here. I have not checked this in any way, and the data date from 2018 so some may have changed.


  • How is Nikita today?
  • What are you feeding her? (could you please recap)
  • What are her Glucose levels?
  • How are you coping with testing?
  • Are you checking for ketones yet?
  • How are you coping with the assist feeding?
  • Is your vet prescribing insulin yet? You might find that they will opt for caninsulin, (it's the goto insulin here in europe) If you haven't discussed insulins yet with the vet it might be worth doing your homework before you have that discussion. I decided I wanted Lantus for George since it's slower acting than canninsulin and overall cats on Lantus have a better chance of remission than those on the faster acting insulins (there are other slow acting insulins eg Levemir, which is also very good)
 
https://www.felinediabetes.com/FDMB...r-more-than-just-carbohydrate-content.175004/

Here is the link to the post that Dr Lisa made on the forum regarding dry food.

Also just wanted to say that none of the options above are novel proteins which, if Nikita has IBD is what you would want to be looking at in terms of food for her. If she likes human food and you could get her to eat cooked food, then maybe that would be a better option. You can get the following supplement from zooplus which you can add to her food to make it a complete diet. It is phosphorus free. Again it is available on german zooplus but not on spanish site:rolleyes:

https://www.zooplus.de/shop/katzen/katzenfutter_ergaenzung/zusaetze/vitamine/547294
 
Thanks @Gill & George! A lot of amazing info!!

I just want to second to stay away form caninsulin since it was designed for dogs hence the name caninsulin for canines. Lantus or prozync are better choices for cats.

probiotics can also really help with constipation and/or diarrhea. I don’t know if it’s available in Europe but a lot of us here use S Boulardii for that.

another option for nausea that Minnie was on is Ondansetron. You only have to cut the pills in 1/2 so it may be worth asking your vet about that too. Was the Cerenia not working then? Ondansetron can be given every day and long term
 
Thank you @Gill & George
All the info provided ia precious to me!
The food is something that worries me alot at this time. She only started to nibble so I don't want to mess with her eating for the time being.
Although I tried to transition Nikita since she was about 2 years old (after her pancreatitis bout), she'd rather starve herself than eat it (tried BARF and Raw).
She simply ignores foods most cats love: chicken, white/blue fish, ham, eggs, cheese, yogurt, etc. She has a clear preference for dry food with chicken, though. As for wet food, I never found a single one that she'd like, she gets tired of them quickly (cheap, premium, ultrapremium, no grain, bio, shredded single protein, morsels, pate, grounded, you name it). The only one that she was consistly eating a bit better were the Royal Canin Renal Wet Chicken pouches.

As for the info asked:
  • How is Nikita today? She seemed perkier in the morning, after Mirtazapine she ate her k/d kibble. But I had to give her a rectal lactulose dosis and since then she seems to be uncomfortable and even with a bit of nausea/pain (?). Right after the lactulose she had a small bowel movement. But she can be like this reacting to the morning pill (1/16 of a 15mg Mirtazipine since she is skinny). The extreme heat also does not help at all, we're all uncomfortable to say the least.
  • What are you feeding her? (could you please recap) Hills K/D dry and Royal Canin Renal Wet pouches (as per vet instructions; Nikita is also having Oralade Cat, so the vet wants her on renal diet for now).
  • What are her Glucose levels? Unknown at the moment. Her vet wants to get her eating and to control de inflamation before moving forward with diabetes/IBD study
  • How are you coping with testing? Since we're not on glucose testing I can only say that I'd would pretty much like to have her full blood pannel ready.
  • Are you checking for ketones yet? no, not yet.
  • How are you coping with the assist feeding? Fairly well. Today I'm not syringe feeding since she started to eat on her own (slowly and not much, but she is). On the past days my main concern was with possible aspiration and that she would never eat on her own again. So, anxiety, fear and sadness have been by my side since all this started.
  • Is your vet prescribing insulin yet? No yet.
 
Olá @Aleluia Grugru & Minnie

I will take a good note regarding the insulin options. I'm bearing in mind the fundamental info provided by @Gill & George and will look for low carbs, since they are nasty for cats. I will need to take slow but firm options on order to have my girl feeling better inspite her medical conditions.

The probiotics are on hold for now since she is still very obstipated and the ones she took not only made obstipation worse but also made her belly inflamation to become more active.
I'm thinking that I will go for Miralax or pumpkin puree to be on the safer side with sugar and nausea (I also gave lactulose myself from time to time and I get a bit nausiated afterwards).
After her rectal lactulose she became a bit unwell (maybe cramps, or nausea and discomfort).

Cerenia was not helping her to eat. We were up for ondasetron but when I also mentioned Mirtazipine for her appetite, the vet told it could help both with appetite and nausea and that's why he prescribed it. I'm starting small with it on order to find the smallest effective dosage for her.

The heat here is tremendous, so I just let her be at her will. Can Mirtazipine leave a kitty a bit drousy?

I'm now off to study the food options provided here, keep an eye on her and give a bit of Oralade Cat later on.

How will I ever be able to repay all your support and guidance? Perhaps never, but I'm tremendously grateful for finding this message board to help me and Nikita on this ordeal ♥️
 
I’m not sure about drowsy but Minnie was on both the anti nausea and the apetite stimulant. If Nikita is nauseated she needs an anti nausea as well or she’ll keep feeling the nausea :)
 
Aleluia Grugru & Minnie said:
I’m not sure about drowsy but Minnie was on both the anti nausea and the apetite stimulant. If Nikita is nauseated she needs an anti nausea as well or she’ll keep feeling the nausea :)
Click to expand...

I thought that Mirtazipine would also help with nausea, but if I notice that nausea is still present I will mention it to the doctor.
The combo heat+ being ill + new meds + obstipation is tough, my poor Nikita just wants to be on her sofa pillow getting the breeze from the fan. I do pray for her to recover without the need for more trial and error, so that we can figure out what's causing what (she will have a study conducted once she feels better again).
 
According to what I've read mirtz does address the nausea, but I have no personal experience of using this.
Drowsiness is a common side effect

https://www.marvistavet.com/mirtazapine.pml hers an interesting link that discusses it's it's es, side effects and dosing, interesting note on dosing in CKD cats.

The Lactulose is not readily absorbed by the intestine, I've read reports that upto 3% can be. This is with oral use, don't know if it's more when taken rectally. Additionally the medicine may have other sugars that could affect blood sugar.

If I were in your shoes I would pop down to your pharmacy and get a monitor and some dtrips to check her blood glucose.
Several reasons for this
  • First and foremost it's the only way to get a reliable reading. This was highlighted to me with one of my cats just recently, he was sick, had a complete blood work, glucose was 185, I tested him the next day at home and he was 60. (the glucose reading you posted forwfor Nikita was 178, honestly that could justvjust be stress) stress can raise BG significantly. Some cats more than others and we have even had cats where their BG drops when stressed.
  • Diabetes, inappetence, lethargy, and systemic stress,(be that constipation, infection, inflammation) are all a perfect recepie for DKA. The only way you can tell is with monitoring, both BG and ketones. Testing a cats BG at home is a very useful skill to have, whether or not it turns out she has diabetes. Here in Spain the pharmacy gave me the monitor free with 10 strips, I got the freestyle freedom lite, it requires a tiny drop so it's easy to use when you are starting out. I would start testing/monitoring both at home right away.
  • You need to get calories into her, keep half your mind on transitioning, but really she needs to eat. Transitioning is difficult for some cats, and can be even harder if kitty is sick
I hope Nikita is feeling better today.
 
Gill & George said:
According to what I've read mirtz does address the nausea, but I have no personal experience of using this.
Drowsiness is a common side effect

https://www.marvistavet.com/mirtazapine.pml hers an interesting link that discusses it's it's es, side effects and dosing, interesting note on dosing in CKD cats.

The Lactulose is not readily absorbed by the intestine, I've read reports that upto 3% can be. This is with oral use, don't know if it's more when taken rectally. Additionally the medicine may have other sugars that could affect blood sugar.

If I were in your shoes I would pop down to your pharmacy and get a monitor and some dtrips to check her blood glucose.
Several reasons for this
  • First and foremost it's the only way to get a reliable reading. This was highlighted to me with one of my cats just recently, he was sick, had a complete blood work, glucose was 185, I tested him the next day at home and he was 60. (the glucose reading you posted forwfor Nikita was 178, honestly that could justvjust be stress) stress can raise BG significantly. Some cats more than others and we have even had cats where their BG drops when stressed.
  • Diabetes, inappetence, lethargy, and systemic stress,(be that constipation, infection, inflammation) are all a perfect recepie for DKA. The only way you can tell is with monitoring, both BG and ketones. Testing a cats BG at home is a very useful skill to have, whether or not it turns out she has diabetes. Here in Spain the pharmacy gave me the monitor free with 10 strips, I got the freestyle freedom lite, it requires a tiny drop so it's easy to use when you are starting out. I would start testing/monitoring both at home right away.
  • You need to get calories into her, keep half your mind on transitioning, but really she needs to eat. Transitioning is difficult for some cats, and can be even harder if kitty is sick
I hope Nikita is feeling better today.
Click to expand...

Hello @Gill & George and @jt and trouble (GA) !

Blessed be by the link regarding Mirtazapine, it has lots of valuable information!

Today is a little less hot but Nikita is still on low power mode. Before going to work in the morning I gave Lactulose again, just as a final atempt on the oral form. When arrived home my parents told me that she does really not have energy. My mother gave her a dozen of her kibble and a water syringe. She hasn't used the litterbox for anything and spent the day sleeping and laying on her sofa pillow and on the chair of my fathers home office.
The wet food that I left her was untouched.

With my mothers help I gave her about 2 ml of Lactulose rectally: she went straight to the litter and a well formed poop came out. She urinated as well.
Afterwards I tried to give her some bits of Calibra Ultrapremium for Sensitive Cats, she took 3 -6 and nothing else.
I also fed her about 15ml (total) of her wet renal food that included 5ml of Oralade Cat. Afterwards she groomed herself and went to have a good drink from her favourite faucet.

She seems more perky now, looking outside the window (even chirping to some birds)

I'm ordering Thrive Complete Chicken and also asked to my usual Farmacy for a glucometer and strips (they will only be available this Friday since only diabetic people with prescription or doctors' letter are able to get them straight away). Today I wasn't able to speak with her vet since he wasn't at the Hospital, will do tomorrow.
Also I'm going to try pumpkin puree mixed with her wet food to see if she gets her bowels to work. Also, I'm ordering Miralax.

Tomorrow she will take her Mirtazipine for the second time (the small dosage of about 1mg that seemed to work yesterday).

We need your good prayers and advices running. And lower temperatures of the air!

As I mentioned before, I do trust my vet, but I'm tempted to get a second opinion (but I'm also afraid that it goes wrong). What's your opinion on this, if you can give one on this subject?

Love from me and my Nikita ♥️
 
They are needed, thank you!

Today the wheather is terribly hot again.

Yesterday I ended up calling another vet in order to get Nikita revaluated. She gave a few advices but will see my girl this Friday, will run some labs and perform a physical exam. For now she says Nikita has to eat, no matter what (without not going overboard with carbs, protein and phosphorus). Also she said that I could try to give her pumpkin puree (which I will) and use lactulose only rectally (to avoid sugar absorption). A small strip of Nutri Vit Plus was given. By nightime Nikita perked up, ate a bit of kibble and looks more alert. This morning she seemed to be hungry but not liking anything we have for her at home. She also wanted to drink water and I know that during morning time she also asked to drink (although she has 2 water fountains and a water bowl available). Mirtazipine was given, but it doesn't seem to have any effect (dose is small, around 1-1,5mg).

Does anyone know a good fiber kibble, that is both low carb, moderate protein and low phosphorus?
I'm waiting for Thrive and Lillys'Kitchen Supurrrs to arrive. Please keep your fingers crossed for Nikita because she is a sweet girl ♥️
 
Margarida said:
Does anyone know a good fiber kibble, that is both low carb, moderate protein and low phosphorus?
Click to expand...
The only low carb kibble (under 10%) I know of that is readily available in Europe is the Thrive. I don't know how it compares to others with regards fibre content.
Bear in mind that most kibble is very high in carbs, and some of the prescription diets for cats from hills and Royal Canin are crazy high, not really appropiate for an animal that is basically an obligate carnivore.



Ask the vet if doing some gentle tummy massage would help stimulate Nikita's bowels??
Getting more water into her will help with the constipation, dehydration will contribute to the problem (even if it is mild), my long haired cat has been having some really hard poops since it got hot, I don't often see her drinking, so she has been getting extra water added to her food to help with that.

Egg Yolk can help with bowel motility, perhaps discuss the use of that with the vet. It is used to help with hairballs, perhaps it will also help with the constipation that Nikita is having problems with.

Good luck tomorrow.
 
Thank you all for the suggestions and good vibes

This upcoming Wednesday Nikita will wave an abdominal ultrasound done by a especialist. Today the attempt to draw blood failed (she was really upset and stressed) so on the ultrasound day the blood will be taken for a full blood pannel (she will be sedated so it will be easier). I also brought a "special litter" in order to colect urine for a urinalysis.

The new vet suspects there might be IBD / Feline Triaditis going on and will also evaluate her CKD. She was adamant that Nikita is not obstipated but that her colon has motility issues instead. When Nikita poops her feces aren't hard/dry, they are well formed and moist.

Since she is starting to eat by herself the vet advised to give her what she likes, provided Virbac Nutribound if needed. She also changed Mirtazipine for a antihistamine (Ciproheptadine). I also have a prescription for Primperan to help with stomach acid, nausea and motility.

The other vet was focused on CKD and never explained why full bloods were not run, if BP was measured and told me that to know ISIS stage a genetic test would have to be run. Also, on the last appointment he told that regarding food it wouldn't be problematic to try whatever meals she likes since she was on a Phosphate binder. She is not and never was, so I corrected the vet and then he told Renal food is mandatory and Mirtazipine would help her in getting to eat the food again.

This vet is focused in bowel issues and is inclined to think that Nikita was incorrectly diagnosed as having cronic kidney disease (she believes that she might have an acute crisis). We will know once all the exams are done. She seemed fairly open to B12, fluids and several protocols that the other vet hasn't mentioned. She also wants to have full bloods, ultrasound, uryanalisis. I just didn't like when she grabbed Nikita so hard that almost chocked my sweet girl (to try to take blood from her jugular since she has fibrosis in both front paws). Her tong was out, she coughed really hard and took a little while for her to breath normally But I did like her whole system approach, how she listened and elaborated a step by step approach.

Nikita is now sat on the balcony (I'm watching her), ate a little bit of her Gourmet Gold Chicken with Carrots tartelette, had a good drink and seems alert. She had a small bowel movement in the dawn and at the beggining of the afternoon and a couple of pees to match.
 
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Awwwwww Poor Nikita I never understand why vets have to be so rough. BUT It does sound like shes a better vet than the last. Sending positives everything gets looked at and treated properly.
geesh some vets!:rolleyes: smh.

Please give little Nikita some scritches from us. :bighug:
jeanne
 
Hi Jeanne! Scritches are more than welcome, she likes them :cat:

I do hope that this vet is able to get a more broad look um what's going on with Nikita because something is deffinetly off. She gets very ill every 12/18 months and the only consistent symptom is colon not working properly, belly inflamation and poor appetite.

This vet will get a in-depth look onto kidneys, thyroid, anemia, diabetes, bowel, etc. Fingers crossed for my tinny girl :bighug:
 
Margarida said:
Hi Jeanne! Scritches are more than welcome, she likes them :cat:

I do hope that this vet is able to get a more broad look um what's going on with Nikita because something is deffinetly off. She gets very ill every 12/18 months and the only consistent symptom is colon not working properly, belly inflamation and poor appetite.

This vet will get a in-depth look onto kidneys, thyroid, anemia, diabetes, bowel, etc. Fingers crossed for my tinny girl :bighug:
Click to expand...
Fingers AND paws crossed!
 
Update: Nikita is eating wet food on her own. Not much, but she is. No meds for appetite for 48h, only Laveolac 1ml with pumpkin puree if her bowels don't work. Also, a little bit of Nutrivit Plus every 48h.

Dry food is given by hand, since her wet food intake is not enough. Our Thrive and Lillys'Kitchen Supurrrs order is terribly delayed, so I researched a bit and decided to get some Feringa foods:
Feringa Single Protein Chicken, Pumpkin and Catnip for wet and Feringa Senior with Chicken for dry. Tried to balance out carbs, phosphorus and protein. Hopefully they will arrive within 3 or 4 days.
The weather is hellish: heat wave running wild. The house has no AC and is sun bathed all day long (fans to the rescue and a portable AC ordered). But she is taking it like a champ, wresting and we're mixing water on her morning Royal Canin Recovery and dinner time Gourmet Gold Chicken and Carrots (not the best foods, but she is eating and we're going slow on her food adaptation). She still has her K/D kibble with some Instinct Original Chicken mixed to keep her interested.

Wednesday is going to be a big day for us. I'm a little concerned regarding sedation for her ultrasound and bloodwork.

I would like to have your opinions on the following, if possible:
What do you think about Feringa choices?
Does anyone knows how sedation works for bloodwork (she is highly reactive and stressed)?

Headbutts from Nikita to all of you that até helping us trhough these puzzling and worrying times :cat::bighug:
 
Gill & George said:
I use the pure chicken with pumpkin and catnip, George likes it. It's low carb and under 1% P. It also hasn't got any additives like gums
Click to expand...

The Feringa formulas seem very interesting and well balanced. I do hope Nikita likes the wet food since pumpkin has been a friend of ours in this constipation crusade! I just checked and they also have a poultry and carrots variety as well, so I will also try that one.

Purrs to George ♥️
 
I am beyond crushed.

The report of the ultrasound is not good: the ureter of Nikitas' left kidney is obstructed/partially obstructed. Also, vascularized mass was found on her upper colon.
She reacted very poorly to the opioid sedation (they gave her less than they usually give when they need to trimm furr on some small pets). Drooled and fought it.

The vet says she is very frail and, by the reaction to sedation, she is concerned that she might not endure a surgery. Also, a biopsy for the mass is needed and both issues are complex, especially the ureter calculus. She is getting in touch with an expert in laparoscopic surgery. I sent her reports to the vet team from the Hospital she has been followed since she is a year and a half old (today I will speak with him).
Sedation took about +6h to wear off, then she pooped a bit, drank from her favouritef faucet.
During the night up until early morning, she ate the only wet food she has been liking (Gourmet Gold Chicken and Carrots tartelette). This morning she peed on her litter.

Currently she is taking Urispás (Flavoxate) every 12h (1/4 of a 200mg tablet). She will also start buprenorphine today, very slowly since she reacted so badly to the light sedation (vet says that the very warm weather, stress and not eating could contributed to the reaction). Giving her bottled water, and trying to get her to eat. She is also taking about 4ml of Virbac Rebound.
The vet mentioned a homeopathic medicine to help her with renal colic.

Do you know if the ureter blockage/partial blockage (ureter, nor urethra) can be sorted with meds? We don't know what type of calculus is since Nikita refuses to use the special litter to colect urine.

Regarding her mass on the upper colon... I don't know how it will be. This new vet informed that a drastic decision might have to be taken soon (risking surgery and having her die on the tablet or euthanasia, where I can be with her and spare her from needles, cuts, pain, etc).

My world is sinking hard, Nikita is the purest only made of love being that gives purpose to my days. She is so young and I feel I'm failling her :arghh:

Edit: the surgeon responsable for the veterinarian hospital talked with me this morning. We agreed in performing a surgery of Nikitas' ureter and a biopsy (or even removal, depending on how things look) for her intestine mass. They know her since she is 18 months young and do believe we need to try or she won't have a chance.
If the surgery won't go well (if things are ugly) I can opt for let her sleep peacefully, knowing all the best was tried. To this group I only ask for prayers, empathy and a little of understanding: Nikita is my everything, she was always by my side in the worst moments and helped me get back on my feet when life thrown me to the floor. That's why I feel like I'm failling her hard. I love her and just hope that she knows in her little tiger heart that it's in the name of love this will be tried.

Pray for us, please. Thank you.
 

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Many prayers for you and Nikita. I am so sorry you received such unsettling news from the US, but I am hoping and praying the surgery goes well. You are doing everything possible to help her vs failing her.
I will keep you and Nikita in my thoughts and prayers :bighug:.
 
Thank you all, prayers are really needed.

I took Nikita to a specialist in ureter surgery. He ran a full blood test (potassium, calcium, all renal values, white and red cells, a true multitude of values that I even never heard off).
Uryanalisis and renal ultrasound was made, in consult with the vet that has performed her abdominal ultrasound 2 days ago.
Her blood, renal, liver, kidney, etc are within range. According to SDMA Nikita is not a CKD girl, contrary to the last years diagnosis and follow-up. They do believe that the colon masses can be an ongoing thing and that it is urgente to get a biopsy done.
Her ureter is partially obstructed with a small crystal/calculus. And she is, for sure, an IBD girl.
This specialist proposed a plan: remove the crystal and get a biopsy done. Afterwards, when biopsy results arrive, we'll ser what needs to be done. He informed regarding the benefits of early surgery since she has good test results, the crystal/calculus position is good (although it is a micro-crystal). He wants to preserve renal funcion and avoid a crash/ER episod with her values getting crazy.

Right now she is at the reference hospital to get surgery. I hope it all works out, She Will be staying there for at least 3 days on which I cannot see her due Covid (they send photos and videos since visits are not allowed).
My heart is in deep pain since I don't really know what will happen. But I had to do something as she was on great pain and that is something I cannot allow.

Edit: surgery went well. The crystal was so small that it couldn't be seen on the microscopic instrument they
use for the surgery (cannot recall the name)...
They will start flush protocol in order for the crystal to pass normally (Nikita surgeon is the best on the field and he is a specialist in urynary tract issues). The biopsy was sent to analysis and we'll have results within 5-6 days. He said that it appears to be a lymphoma but we must be positive about all this.
And I also got the conformation that my Nikita does not have CKD. Her bowels were the ones failling her body. And I failed on getting her the best care up until now. And the vet hospital where I was taking her since she was 18 months old failed her even harder. I'm overwhelmed, sad and drained. But I will fight for Nikita, she is my soul ♥️
 
Thank you @jt and trouble (GA) and @Tomlin ♥️♥️♥️
Please keep Nikita in your loving thoughts and prayers.
Here's a photo of her sent by the Hospital (due Covid I cannot visit her). She's my everything ♥️
 

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