? Sunny dx'd with triaditis

Holly and Sunny Bear

Holly and Sunny Bear

Active Member
Sunny's been in remission since 2023 but has been inching up in his numbers recently. I took him to the vet and he was diagnosed with triaditis which i think explains the rise in BGs recently.

The vet had me quit his cosequin, gave him a shot of covenia, and is recommending a diet change as she thinks this stems from IBD.

She's recommending hills m/d or d/d or royal canin pr, but these are all too high in carbs. M/d is the lowest of them all at 13%. Currently he eats only fancy feast beef pate at 3% carbs.

I suggested Koha rabbit which is 4% carbs but she is concerned with the high phosphorous level in koha bc of his age and he has slight kidney impairment.

So I'm at a loss. She's says it's only for a month or two depending on how he responds to a food change. But I don't want to go above 10% carbs if I can help it.

His only IBD symptom has been occasional vomiting after a meal.

He'll be getting another shot of covenia on November 11th.

Any ideas on a good food for this?
Thank you,
Holly & Sunny
 
Ugh, sorry for the possible diagnosis. I am dealing with a similar (CKD + IBD) at home and rabbit is one of her foods. Rabbit is generally a bit higher phosphorus, but like Sunny, her phosphorus numbers are fine on her labs. You have a few options. One is to try rabbit for a while, and see if he does better on it. There are several other brands with rabbit options that might have lower P values. Worst case, his phosphorus numbers go higher, and you have to add a phosphorus binder. Or you could try another protein like lamb, kangaroo, venison that is novel to Sunny.

What is the Convenia supposed to do for him? It's an antibiotic designed for skin infections.

Did Sunny have an ultrasound? It's the first step, but not final step in an IBD diagnosis. How did they diagnose the triaditis? Has he had his B12 levels tested? Many cats with IBD issues have low B12 (not mine though).

Other things to consider with IBD are getting him on a good probiotic, such as Visbiome, and a prebiotic like psyllium husk fiber.
 
Thanks @Wendy&Neko for this info! :bighug: You helped me make a food decision. :)I ordered some of the Koha rabbit for now -- and will research other ones for the future, based on your suggestions. Koha is pretty pricey too 😣
I'll keep the binder in mind if we end up needing that. Until we get the koha I have cut out treats and extras, and we're just sticking to fancy feast beef only.

I'm not sure why the vet chose convenia - I'll ask her and see if we can do something more geared for the digestive track like metronidazole. We haven't done an ultrasound but she did mention we will want to do that if his situation doesn't improve after a month of antibiotics and the food change.

At this point the vet says she only suspects triaditis based on his blood work.
These were the abnormal values. I've attached his bloodwork - and will add it to his spreadsheet.
ALT 159 normal is 27 - 158 U/L
AST 80 normal is 16 - 67 U/L
Basophils 0.148 normal is 0 - 0.1 K/µL
MCH 18.1 normal is 12.3 - 17.3 pg
MCHC 35.9 normal is 29.1 - 35.7 g/dL
Spec fPL 7.3 normal is 0.0 - 4.4 µg/L

Here's what she wrote:
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"Sunny does have slight elevation of ALT & AST, but other liver parameters like Bilirubin, ALP, GGT are normal. High blood sugar and diabetes can cause a secondary reactive liver, however, when he was diagnosed with diabetes, his liver enzymes were normal, so that scenario makes less sense.
The liver can also react to GI inflammation or pancreatic inflammation. Primary liver disease could include immune-mediated inflammation or bacterial infection in the liver. With rapid weight loss we can see fatty liver disease but those cats should have a high ALP enzyme.
I can easily screen for pancreatitis with an added on lab test called specific lipase, which I can order from the blood already at the lab.
Usually signs of GI inflammation you would see some sporadic vomiting or stool changes.
The tough part, thereafter, if we want to look more specifically at his liver, it would require an abdominal ultrasound and liver needle aspirate or biopsy. This would have to be done by the internist Dr. Culver at Bridger Veterinary Specialists.
Since these enzymes are mildly elevated, it would be reasonable to recheck a liver panel in 4 weeks to see if these changes persist. And in the mean time tightening the belt for low-carb to minimize blood glucose changes.

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Spec fPL 7.3 (0.0 - 4.4 µg/L)

Spec fPL® concentration is in the equivocal range (4.5 - 8.7 μg/L) and pancreatitis is possible. Investigate for other diseases and consider additional diagnostics and/or treatment if clinical signs or other evidence of disease exist. Recheck Spec fPL in 2-3 weeks.

Knowing his mild liver enzyme elevation and mild elevated pancreas level, this likely means mild "tri-aditis" which is a plain term to indicate inflammation of pancreas, liver and GI tract (3 organs, hence "tri" and inflammation of "aditis"). This occurs due to the ducts that connect the 3 organs together. It can be difficult to tell which organ the inflammation started in, although usually it stems from underlying IBD (inflammatory bowel disease) which is immune-mediated. And gut bacteria can reflux and be moved from the small intestine into the liver. So some of these cats need antibiotics and others need steroids. About 40% of cats with IBD can lessen inflammation on their own with a hypoallergenic diet. I would have to get a nutrition consult from Hills or Royal Canin to find a low-carb hypoallergenic diet. Steroids would definitely make glucose control very challenging since a side effect is hyperglycemia, and potentially full blown diabetes.

His mild pancreas inflammation likely explains the higher glucose numbers you've been seeing.
I propose we do 4 weeks of antibiotics (Convenia injections - two injections total, 2 weeks apart). Then recheck his liver enzymes & fPL."
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We did not test his b12 levels so i will ask for that at his recheck - and I'll start his with probiotics and prebiotics - luckily I already have those things for my other non-diabetic cat Alma who has chronic IBD. I've been using this one from Royal Canin and it has worked wonders for Alma.

The good news is that Sunny seems to be feeling better this week and he had a green morning BG today so I think we're on the right track. :cat: I keep hoping this turns out to be irritation from the cosequin I had him on for the last 6 weeks or so. I've quit the cosequin and we'll check into solensia if he needs it. he has some arthritis.
 

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Oh hey, a subject I'm versed in!😅
For ibd, you have 2 save choices. If your cat will do raw, it is always the best. And rabbit is often considered the gentlest of proteins for cats with ibd. But if your have a senior or a cat with Hyperthyroidism, you need to not use those pre-made recipes you can buy like Viva. The reason rabbit is usually higher in phos, is because it costs quite a bit to debone rabbits. When I was using raw I had to quit viva, but found a company called Raw Feeding Miami that sold boneless rabbit. Fun.
If your cat won't eat raw, there's a better chance it'll eat cooked. I cook meat I'm able to pick up from the grocery store for 2 of mine. I chop it up and weigh it, cook it in water, so any nutrients cooked out with be fed with the homemade broth it turns into, and add EZ Complete. It turns any meat into a complete and balanced meal for your pet. And it really doesn't get more pure than that. I feed it to my diabetic and another with bad ibd that can't eat any cat foods on the market.
 
Tyleete said:
Oh hey, a subject I'm versed in!😅
For ibd, you have 2 save choices. If your cat will do raw, it is always the best. And rabbit is often considered the gentlest of proteins for cats with ibd. But if your have a senior or a cat with Hyperthyroidism, you need to not use those pre-made recipes you can buy like Viva. The reason rabbit is usually higher in phos, is because it costs quite a bit to debone rabbits. When I was using raw I had to quit viva, but found a company called Raw Feeding Miami that sold boneless rabbit. Fun.
If your cat won't eat raw, there's a better chance it'll eat cooked. I cook meat I'm able to pick up from the grocery store for 2 of mine. I chop it up and weigh it, cook it in water, so any nutrients cooked out with be fed with the homemade broth it turns into, and add EZ Complete. It turns any meat into a complete and balanced meal for your pet. And it really doesn't get more pure than that. I feed it to my diabetic and another with bad ibd that can't eat any cat foods on the market.
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Thanks @Tyleete! I appreciate that! I have never tried Sunny with raw anything - but I bet he would eat it. He likes everything which is probably why we're in this mess. :cat:
I'd rather not cook up rabbit 🤢 in my kitchen -- but I used to have to feed my old dog tripe - so I guess I can handle rabbit. thank you for this insight!
 
Holly and Sunny Bear said:
Thanks @Tyleete! I appreciate that! I have never tried Sunny with raw anything - but I bet he would eat it. He likes everything which is probably why we're in this mess. :cat:
I'd rather not cook up rabbit 🤢 in my kitchen -- but I used to have to feed my old dog tripe - so I guess I can handle rabbit. thank you for this insight!
Click to expand...
Don't blame you on the cooking bunnies. I either feed it raw where I couldn't tell what it was, or kibble to others.😅 I cook pork tenderloins, chicken breasts (but my ibd doesn't eat any poultry), beef, or lamb. I don't do bones or skin. And done like that, there's are no carbs to be had. I just try to keep the sodium 75 per serving, which is usually 4oz. I've got 4ibd babies, each to varying degrees. Had 1 fella that had what I called puddle poop since I took him in off the street. Years and years of trying stupid rx foods, nothing worked into the raw rabbit for him. His 2nd day on it was the first solid stool I'd seen from him. I nearly took a pic and put it on the fridge! 🤣
Best of luck to you both.
 
Tyleete said:
Don't blame you on the cooking bunnies. I either feed it raw where I couldn't tell what it was, or kibble to others.😅 I cook pork tenderloins, chicken breasts (but my ibd doesn't eat any poultry), beef, or lamb. I don't do bones or skin. And done like that, there's are no carbs to be had. I just try to keep the sodium 75 per serving, which is usually 4oz. I've got 4ibd babies, each to varying degrees. Had 1 fella that had what I called puddle poop since I took him in off the street. Years and years of trying stupid rx foods, nothing worked into the raw rabbit for him. His 2nd day on it was the first solid stool I'd seen from him. I nearly took a pic and put it on the fridge! 🤣
Best of luck to you both.
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Haha!!! I get it. I'd get that perfect poo picture framed after all that struggle. 🤣
 
I use premanufactured raw, or freeze dried. Mine has currently gone off of raw. Sigh! Primal or Stella & Chewy's have both frozen and freeze dried raw rabbit options. There are others too, like Vital Essentials. I know more, but might be just Canadian options. Probably costs more to buy premade, but easier than making your own. And an easier way to try raw rabbit until you know he'll eat it.
Holly and Sunny Bear said:
see if we can do something more geared for the digestive track like metronidazole.
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Definitely not a good first choice. It can also upset the tummy flora balance. It's not being given as much now as it used to be.

The probiotic you linked is basically B12 + S. boulardii which is a probiotic yeast. S. boulardii is great for poo problems, and you might be able to get it cheaper by itself. The Visbiome is a real probiotic. Think of the S. boulardii as being great at mopping up the bad flora, the other probiotics replace the low levels of good tummy flora. You can give both. However, S. boulardii doesn't work if their B12 levels are naturally low. Don't get his B12 tested until he's been off the B12 for a while, or the test won't be meaningful.

And since his Spec fPL is high, another post for you: A Primer on Pancreatitis. Pancreatitis is often a companion with IBD or small cell lymphoma. I just have the one with IBD, but last three cats taught me a lot about small cell lymphoma. IBD kitty also has SCL, but it's been in remission for many years. You usually need a biopsy to differentiate between SCL and IBD. If the novel protein doesn't work, you may need more diagnoses to switch up the treatment.

If steroids are ever needed, budesonide is an option that doesn't impact BG's as much. That's what Neko was on.
 
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