1/31 - Gen, AMPS 349, PMPS 124

Yesterday

To recap: Gen's dental surgery has been postponed due to my vet's concerns about his GI issues and exam results. (She described him as "medically complex.") I have not gone over the labs yet, but vet sent a very detailed response to my questions from yesterday, and I've been going through them.

The next steps she has in mind, as I understand them, are as follows: continue the ondansetron/gabapentin/mirataz combination we've been using to address inappetence/presumptive pancreatitis, get an abdominal ultrasound and consult with an internal medicine specialist re: GI issues/potential IBD, and potentially start him on marbofloxacin for a possible UTI. Well, and we're waiting for the results on the acromegaly test (I think this is the IGF-1 test, specifically).

My vet practice works with an ultrasonographer/internal medicine specialist who comes in periodically; her next availability is February 13, and they are checking to see if she can come in sooner (but apparently this is doubtful). I have asked for clarification as to whether she thinks this delay is safe/appropriate for Gen's current condition. They can refer me to a specialist at one of the local animal hospitals who could see us sooner, but it would be more expensive; there are also significant benefits to working with someone who has a close collaborative relationship with my vet. So I'd really prefer to go with her, if we can afford the delay.

I think, based on this assessment, that we probably can (but I am waiting for her to confirm before I decide):

Clinically, I would describe Gen as sick but STABLE. I believe he's compensating well for everything that he's dealing with but if we had proceeded on Monday, we could have pushed him into crisis, which is the absolute last thing I would have wanted, (as much as I want to take care of that darn infection). Things that should prompt you to take fast action are: extreme lethargy, vomiting that won't stop, yellowing of the skin, eyes or mucus membranes, collapse, respiratory distress, inappetence even with the use of Mirataz.

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(None of those symptoms apply, thankfully.)

I'm not going to change his diet yet; he's been through a lot of dietary changes recently, and I think we don't want to rush his system into anything. I have, on her advice, stopped giving him either the psyllium husk or Miralax. We'll see how he goes from there. In the meantime, I've been doing research into possible limited ingredient diet/novel protein options to discuss with her.

He's eating well and has been pretty chill today, but he's also having such a flat, pink cycle. Sigh. I think I am going to switch to TR, now that he doesn't have an imminent surgery planned. Any thoughts on this?

Wendy&Neko said:

When was the blood taken for the acro test? The vet visit on the 28th? Just asking cause research out of the Royal Vet Clinic said that testing should be done no sooner than 73 days after starting insulin. Though I've seen another paper say 8 weeks (56 days) was OK. And it's been about that. About 1/3 of cats tested too soon get false negative for acromegaly. BTW, I don't think acro when I look at his spreadsheet, I think "really needs a dental". We've seen acros on low doses here, but the recommendation to test when at 6 units is because at that size dose, it's very seldom anything else except IAA or Cushings. Of course, we've seen low dose Cushings and IAA too. But I don't see IAA in his spreadsheet either.

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Yes, the blood was taken on the 28th. I've expressed my skepticism re: acromegaly in the email I just sent my vet - I'm curious to see her response - but that said, if the results come back positive, I guess that means we're catching it earlier than is clinically standard, which can only be a good thing. (In addition to the bone remodeling and relative insulin resistance, she's also looking at some developments with his heart and kidneys that, while not top concerns at this stage, could be consistent with hypersomatotropism. And Gen fits the common age range for acro, as well as being male and fixed. None of which convinces me, but we'll see what the test results are.)

Do you happen to have a link to the Royal Vet Clinic recommendation, by the way? (No worries if it's not easily available. I can dig for it myself later, too.)


Phew. How I long for a day when I can just say, oh, there's not much to report!

I hope you're all having a relaxing and uneventful weekend, friends, and that your kitties are surfing safely.

Sorry for bumping your last thread instead of this one - I just really wanted to respond to the food point you'd made there!

Again, I feel like we just went through the same whole runaround (although we did the dental, which did mess us up, so it makes me gladder that they canceled it for now instead of making everything worse!). I don't say this to compare, only to say that holy crap, your situation is familiar. I know exactly how you're feeling!

And waiting to even get to see the person who might have some insight is always the freaking worst. Agh. It's all so frustrating and scary. Everything is urgent and yet doesn't move at the same time.

I wish I had any real answers or advice for you, but it seems like I'm only a few steps ahead on the board. Regardless, I'm here and thinking of you and your sweet boy. I can't wait until you have a nice, simply, not-much-to-report day either.

Brianna & Xander said:

Sorry for bumping your last thread instead of this one - I just really wanted to respond to the food point you'd made there!

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No worries at all. I appreciate the recommendation and insight! I went through a bunch of the non-raw "limited diet" wet food options on Chewy last night, and Koha was the brand that was standing out to me the most (although I was hoping to avoid the rabbit, as the most expensive option ... duck, turkey and venison were all looking like possibilities, and it just so happens that my vet's recommendations were mostly venison as well). It's good to know about the can problem.That could just about drive me batty, but forewarned is forearmed! Anyway, like I said, I'm not jumping for anything new yet, but I'll be discussing with my vet.

Brianna & Xander said:

Again, I feel like we just went through the same whole runaround (although we did the dental, which did mess us up, so it makes me gladder that they canceled it for now instead of making everything worse!). I don't say this to compare, only to say that holy crap, your situation is familiar. I know exactly how you're feeling!

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Honestly, the first thing I thought when I got her email which brought up IBD and very slightly elevated proBNP was, jeez, are we copying Brianna and Xander, here? Solidarity is a nice thing to have when dealing with complicated and alarming medical stuff, though. All the hugs to you and your sweet boy - you're on my mind too.

I'm feeling significantly better today - I generally do when I'm able to understand the information and sort out some kind of order of operations. And it helps that Gen seems to be feeling pretty good, and there was no repeat of the poop in the bathtub. That scared me because, like my vet, I suspect it represented significant discomfort. (Also, it stained, I had to soak the area in Barkeeper's Friend and scrub the hell out of it!)

Will keep on keeping on ...

Allie & Gen said:

duck, turkey and venison were all looking like possibilities, and it just so happens that my vet's recommendations were mostly venison as well). It's good to know about the can problem.That could just about drive me batty, but forewarned is forearmed!

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I had considered duck in particular too, but I saw so many people just saying that all fowl and related things were a no-go for their IBD cat and I figured just get as far away as possible and hopefully avoid wasting time. Not that that's necessarily the right thing for you and Gen! Just my thought process lol The kangaroo I think seemed even more expensive, so I'm not sure that'd be on our list to try unless there were no other options. And yes! That's why I wanted to you know. It gives me anxiety every time I get a case (I get one today, yaaay...) but if it's what I gotta do, it's what I gotta do.

Allie & Gen said:

Honestly, the first thing I thought when I got her email which brought up IBD and very slightly elevated proBNP was, jeez, are we copying Brianna and Xander, here? Solidarity is a nice thing to have when dealing with complicated and alarming medical stuff, though. All the hugs to you and your sweet boy - you're on my mind too.

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I hope not, for both of your sakes! But you're right, solidarity is really nice. We know that no one can really get what we're dealing with in general aside from this forum, but it seems like we can relate on an even deeper level. Or poor guys are apparently really similar. Maybe more good can come out of that, in terms of one of us finding something that works and sharing it with the other!

Allie & Gen said:

I'm feeling significantly better today - I generally do when I'm able to understand the information and sort out some kind of order of operations. And it helps that Gen seems to be feeling pretty good, and there was no repeat of the poop in the bathtub. That scared me because, like my vet, I suspect it represented significant discomfort. (Also, it stained, I had to soak the area in Barkeeper's Friend and scrub the hell out of it!)

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So glad to hear it!! I know what you mean, needing time to process and plan (which sometimes has to wait until the initial stress and overwhelm and despair wane a little). And I'm so glad Gen seems to be feeling pretty good today! Jeez, though, staining. Like you said, what kind of discomfort must your sweet boy be feeling to do that there and for it to be so... gnarly? Poor guy.

I cannot recommend Smalls enough. They have pork which is Indy's absolute favorite. It is low carb and gently cooked. Thankfully he is still able to have other proteins as well, we are lucky there. But, that is probably because of him being on the Chlorambucil. I think I can get you a free sample box if you are interested. (I swear I should work for them or Astros oil).

Allie & Gen said:

(None of those symptoms apply, thankfully.)

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Thank goodness - this worried me!

My current kitty sees a visiting ultrasound vet. Been seeing her for years and she knows my cat. So much so that when my vet retired (sob!!) I made sure the new clinic gets visited by the same ultrasound vet. A couple weeks wait should be fine.

If he's on all LC now, I would absolutely switch to TR now. He'll feel better in overall better BG numbers.

Regarding cans, I don't feed the Koha. The bones in the rabbit is a new thing I didn't see years ago when I tried it. But my little miss can't do green lipped mussels and Koha has that. Note, sometimes allergies are as odd as to the type of gums used in products. It does take some detective work to figure out what works. I created a "vomit log". I write down date/time of vomit, what it looks like, how soon after food, and what food was eaten.

Not all single ingredient foods advertise as "limited ingredient". Hounds & Gatos and Identity being two such brands, in addition to the Rawz I mentioned. Lamb is probably one of the cheaper proteins, along with pork. Identity has both, as well as buffalo/bison.

Regarding time frames for testing IGF-1, the original place I saw it was on the RVC Diabetes Remission Clinic FB page, on a video by Dr. Vanessa Woolhead that is no longer available. However, in the 2025 iCatCare consensus guidelines on the diagnosis and management of diabetes mellitus in cats. Second paragragh under the title of Diagnosis under Figure 3 talks about the wait time for taking blood being up to 8 weeks. Note, when you read that article, the ranges for positive or gray zone for acromegaly are for the labwork done in England. Michigan State University, where Gen's blood went, have slightly different ranges.

Also note from that same document "Most cats with HST (75%) have no phenotypic changes that can be identified through a physical examination that distinguish them from regular diabetic cats." Neko did not have any noticeable changes, other than ravenous appetite, until years after her diagnosis. Table1 shows heart murmurs are almost as common in diabetics with and without HST (hypersomatotropism) the official but overly long name for acromegaly.

Brianna & Xander said:

I had considered duck in particular too, but I saw so many people just saying that all fowl and related things were a no-go for their IBD cat and I figured just get as far away as possible and hopefully avoid wasting time. Not that that's necessarily the right thing for you and Gen! Just my thought process lol The kangaroo I think seemed even more expensive, so I'm not sure that'd be on our list to try unless there were no other options. And yes! That's why I wanted to you know. It gives me anxiety every time I get a case (I get one today, yaaay...) but if it's what I gotta do, it's what I gotta do.

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Good to know about fowl! (And yeah, the price of kangaroo means I wouldn't even consider it, honestly. I'm also just super uncomfortable with the idea for some reason, though that probably bears examination.)

Jessica & Indy said:

I cannot recommend Smalls enough. They have pork which is Indy's absolute favorite. It is low carb and gently cooked. Thankfully he is still able to have other proteins as well, we are lucky there. But, that is probably because of him being on the Chlorambucil. I think I can get you a free sample box if you are interested. (I swear I should work for them or Astros oil).

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Thank you for the recommendation! I have to admit, though, I am a little put off by the fact that their website won't give me any kind of price range or estimate at all without giving them personal information first. I am not doing at all well financially, and even less so with the strain all the testing and vet visits are putting on my limited resources. (All the IBD-friendly food is painfully priced, for me, but I can't help suspecting that a fancy bespoke diet would leave the rest in the dust.) Do you have thoughts on cost? I don't really want a free box of something we can't afford to get again, though I really appreciate the offer.

Wendy&Neko said:

Thank goodness - this worried me!

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I certainly wouldn't be quiet about it if any of that came up! Apart from some toilet irregularities and somewhat variable affect, he's not showing any new or scary symptoms. He's eating quite well and there's no vomiting whatsoever, not so much as a hairball in weeks. (When he had one of those last, it seemed clear that I hadn't done a good enough job of cleaning up all the hair from pre-Libre installation shaving. )

Wendy&Neko said:

If he's on all LC now, I would absolutely switch to TR now. He'll feel better in overall better BG numbers.

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He is! He's currently eating all Fancy Feast, mostly classic pate along with flaked tuna. According to the food chart, the carb content of the flavors he's eating ranges from 1%-5%. I give him some Fortiflora and sometimes a little freeze-dried rabbit or tuna with it, and Nexabiotic, but that's it. (I have kibble in reserve in case of sudden appetite issues, but so far, so good.)

If we're switching to TR, I think I can give him a .25u increase tonight? He's had a mix of nadirs on this dose, but several have been below 200.

Wendy&Neko said:

Regarding cans, I don't feed the Koha. The bones in the rabbit is a new thing I didn't see years ago when I tried it. But my little miss can't do green lipped mussels and Koha has that. Note, sometimes allergies are as odd as to the type of gums used in products. It does take some detective work to figure out what works. I created a "vomit log". I write down date/time of vomit, what it looks like, how soon after food, and what food was eaten.

Not all single ingredient foods advertise as "limited ingredient". Hounds & Gatos and Identity being two such brands, in addition to the Rawz I mentioned. Lamb is probably one of the cheaper proteins, along with pork. Identity has both, as well as buffalo/bison.

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It's hard to know what Gen might or might not be reacting to - while a single-protein diet may be recommended for IBD, I don't yet know anything for sure! I have enough human friends with complex food sensitivities to know how detailed and trial-and-error a process it can be to figure out what works. I'm not really ruling things out yet ...

The name, Rawz, seems to imply raw food, but I can't seem to find confirmation one way or another anywhere on their site, except that they mention the importance of properly cooking pork. ETA: found confirmation that it's cooked, though also a little tricky to find (and very pricy). I'll look at Hounds & Gatos and Identity!

Wendy&Neko said:

Regarding time frames for testing IGF-1, the original place I saw it was on the RVC Diabetes Remission Clinic FB page, on a video by Dr. Vanessa Woolhead that is no longer available. However, in the 2025 iCatCare consensus guidelines on the diagnosis and management of diabetes mellitus in cats. Second paragragh under the title of Diagnosis under Figure 3 talks about the wait time for taking blood being up to 8 weeks. Note, when you read that article, the ranges for positive or gray zone for acromegaly are for the labwork done in England. Michigan State University, where Gen's blood went, have slightly different ranges.

Also note from that same document "Most cats with HST (75%) have no phenotypic changes that can be identified through a physical examination that distinguish them from regular diabetic cats." Neko did not have any noticeable changes, other than ravenous appetite, until years after her diagnosis. Table1 shows heart murmurs are almost as common in diabetics with and without HST (hypersomatotropism) the official but overly long name for acromegaly.

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Thank you, that's all very useful and helpful to consider!

If you got 28 packets every 4 weeks (they store in the freezer) it would be about $4/day. A 10 lb cat should eat a packet a day.

Jessica & Indy said:

If you got 28 packets every 4 weeks (they store in the freezer) it would be about $4/day. A 10 lb cat should eat a packet a day.

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Hm, okay, that's comparable to the other things I'm looking at (if much more than I'm paying now).

Oddly, when I started filling out the "start here" prompts on the website, it told me I should check with my vet because their food might not be for cats with pancreatitis. Clearly it works for Indy, though?

(I'm sticking with what I'm feeding Gen right now, for now. But I'm interested in learning more.)

Cozy critter.

You could do that increase tonight. However, it does look like he might be breaking a bounce tonight, and a bounce breaking cycle with an increase can be more "interesting". See whether he still slides down to PMPS to confirm if bounce breaking. If yes, I'd increase at AMPS.

FWIW, I made a lot of Neko's food with a meal completer. Priced out, it was cheaper than some of those canned options.

Wendy&Neko said:

You could do that increase tonight. However, it does look like he might be breaking a bounce tonight, and a bounce breaking cycle with an increase can be more "interesting". See whether he still slides down to PMPS to confirm if bounce breaking. If yes, I'd increase at AMPS.

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I was coming here to say more or less exactly that - I will hold off on the increase, as it looks likely that I'll be shooting the lowest number I ever have as it is, and I would really like to sleep if I can.

Wendy&Neko said:

FWIW, I made a lot of Neko's food with a meal completer. Priced out, it was cheaper than some of those canned options.

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Do you mind if I asked how that worked? (How you picked the meal completer, and whether you used some kind of recipe?) I'm trying to gauge effort levels, energy, time, etc, to see how they can fit in with my other obligations. I'm inclined to think that a fully homemade diet for Gen is probably unrealistic at this point in my life.

I used a couple of different meal completers (premix). One, TC Feline, is made a hop, skip and a jump away from where I live and fairly inexpensive. They also had an option that is kidney friendly. The other FoodFurLife's EZComplete was the other one I used. It was created by some folks who had IBD cats. There is another one Alnutrin, created by former FDMB members. All three of those have recipes on their website and with the product. First question is whether you want to make raw or cooked. Some premixes work with cooked, some don't. I've seen some premixes say you have to add liver and that crossed the line of how fussy I wanted to be.

After getting the supplies, the effort was to get out a large bowl, add meat, water, premix (and egg yolk for TC Feline) and mix it all together. I have a kitchen scale that I would use to measure out ingredient amount (water and premix) and daily amounts. I got some small freezer friendly containers that fit about one days's worth, which was 220 grams each for Neko and her buddy. After mixing I filled the freezer container to the right amount, put the lids on and froze. Every night I'd take out the next days allotment of food. If not feeding raw, you'd have to gently poach or fry the meat first. I'd usually make two weeks worth of food at once for two cats. Took me about 1/2 hour to make and saved time on food shopping, so no extra effort.

The other task is getting the meat. Easy or hard depending what protein you use and how easy they are to obtain. I have an organic exotic meat butcher near me, and used to have a raw pet food store that sold preground meat. Neko used to get some fancy ones, buffalo, elk for example, but also plain old chicken and turkey. Tip, start with the cheapest meats first, you don't want kitty to love only the expensive stuff.

@Wendy&Neko Thank you! I'll look into the completers, and see what's available around here. Certainly I ought to be able to get pork or lamb, but affordability is a whole other thing.

Definitely on the affordability. Food prices have gone up a LOT since I made cat food. But so has the canned product too.

True ... but I live in an infamously expensive city, unfortunately, and locally-sourced high quality meats might be a lot more here than many places. In any case, we'll see how things progress.

This is certainly an interesting couple of cycles ... he went lower breaking his bounce than he has in the past, but as soon as I fed him he shot up like a rocket. Then about 45 minutes after his shot, he suddenly slowed his climb; still going up, but less steeply. Huh.