? 12/10 Sunny AMBG 316 - potentially out of remission

[Holly and Sunny Bear]

Well....we're back Sunny (15 years old) has been doing great and in remission since August of 2023 - but recently had slightly rising BGs in late October - based on bloodwork (elevated liver enzymes and pancreatitis) the vet suspects triaditis but it's not confirmed. She suspects underlying IBD - although he has never had a loose stool - he does vomit a couple times per week. We switched him to an all rabbit food diet which seemed to be helping (and his November bloodwork showed improved pancreatitis marker but slightly worse liver enzymes). The vet and I decided to wait and recheck bloodwork after a month of the diet change. But then on 12/03 I gave him a dehydrated duck treat -- and that night he came to me crying really loud and hissing - obviously in pain. We rushed him to the ER vet and they couldn't find anything much wrong although his liver enzymes were up a little higher. And he has slightly elevated kidney disease indicators. They did not have a pancreatitis test there (what???). Anyways -- they gave him methadone and fluids and sent him home with me - suspecting triaditis flare. My regular vet agreed the next morning that it was likely triaditis flare - and started him on budesonide and cerenia and continued gabapentin. She thinks he will only need the budesonide for a burst of 2 to 3 weeks. This course has really helped. Sunny was quite sick for a few days with obvious discomfort but got gradually better, and now, a week later he is acting completely comfortable and like himself.

However -- I checked his BG this morning and it's 319 (3 hours after his 6am meal)! I was aware this could happen from the steroids but was hoping the budesonide wouldn't affect his BG this much. I'm doing a curve today to see how this trends..... But looking for your thoughts on what to do about insulin....if anything - he has 2 more weeks of budesonide left (not sure if he will need it beyond).
Uggh! I really hate to have to go back to insulin.

 

[Mary & Jude]

Awwwww... I can't offer dosing advice, but I'm SO sorry to read this. I hope this is just steroid induced, and that you can quickly get him back into regulation.

 

[Holly and Sunny Bear]

Am I dreaming to believe he might only need steroids for this 2-3 week burst? From what I'm reading, it sounds like most triaditis cats need steroids for life

 

[Tyleete]

I'm new to the diabetic world, but can speak about ibd. I've had way too many of those, especially food related.
I currently have 4 with ibd and 3 are food related. Each are allergic to any fish, ask gums and every kind of poultry. Usually, if they're allergic to one type of bird, they're allergic to all of them. Not always, but most of the time. The duck treat might be bad for him. I have to stick to beef & pork treats for those, which are just freeze dried treats.
And it's odd, but ibd cats can have 1 of 2. Diarrhea or constipation. One of my gals had the latter.
That's all I can help to contribute.
Oh! Watch out the phosphorous amount in rabbit food. Because it takes more effort to debone those little fellas, they usually leave it in and the phos level will be higher. For seniors it can be a bad thing. I had 1 guy that nothing worked except raw rabbit. After realizing viva raw had too much in it, had to go about buying boneless rabbit.
Hope your baby's numbers come back down and he's feeling better real soon.

 

[Holly and Sunny Bear]

Right now the vet says she's more concerned about the high protein in the rabbit food. His phosphorous levels are in the normal range for now.... I don't know what the heck to do food wise.

 

[Tim & Pookey]

Right now the vet says she's more concerned about the high protein in the rabbit food. His phosphorous levels are in the normal range for now.... I don't know what the heck to do food wise.

Hey Holly, I'm going through something similar right now with the food and kidney values. Diabetes and CKD together makes it tough.

Sunny Bear's kidney values don't look crazy to me right now. Creatinine a little elevated from last year. Phosphorus OK. Was there a SDMA value in his recent labs?

In our case, what I decided was that I'd prioritize the diabetes for now with low-carb food. Take some load off his kidneys that way by trying to keep blood sugar regulated (anti-jinx). We're adding a good bit of water to his food to try to keep him hydrated too.

Dehydration and inflammation can impact the traditional kidney markers. Maybe some of that going on in your case. Might be worth checking labs again in a couple months to see where the kidney values are trending.

 

[Tyleete]

Right now the vet says she's more concerned about the high protein in the rabbit food. His phosphorous levels are in the normal range for now.... I don't know what the heck to do food wise.

While rabbit is typically the safest, pork is also considered very safe & tolerated but ibd cats with food allergies.
I don't know if you are buying, cooking, or get raw; but I do home cooked to make sure my 1 guy I have his with the worst issues isn't getting what he shouldn't. I know raw is best, but only 1 of mine had ever eaten the raw. I just buy Natural pork tenderloin from Smithfield I think. At my local Walmart, cause I can't afford local butchers. But I bake it in a pan with lots of water so when any nutrients that cook out (as well raw feeders complain about), create a healthy broth to serve with it. My cats like it shredded. I only have to add EZ Complete to it and it's perfectly balanced.
Why does your vet not want high protein? Is it from one of the other illnesses? High meat protein is all I've been taught, but mine don't have the other ailment yours does

 

[Tyleete]

Hey Holly, I'm going through something similar right now with the food and kidney values. Diabetes and CKD together makes it tough.

Sunny Bear's kidney values don't look crazy to me right now. Creatinine a little elevated from last year. Phosphorus OK. Was there a SDMA value in his recent labs?

In our case, what I decided was that I'd prioritize the diabetes for now. Take some load off his kidneys that way by trying to keep blood sugar regulated (anti-jinx). We're adding a good bit of water to his food to try to keep him hydrated too.

Dehydration and inflammation can impact the traditional kidney markers. Maybe some of that going on in your case. Might be worth checking labs again in a couple months to see where the kidney values are trending.

I've had 4 kidney cats now, I've done rescue a long time. The first 3 I listened to the vets and fed the low protein they said I had to, to protect them. I watched them all wither away to nothing and it was awful. It wasn't until I spoke with the lady from Food Fur Life, that changed my way of thinking. She even showed me research saying low protein is good for no kitty, and we're only hurting them with those old myths.
I followed what she'd said with my 4th. He had been eating fancy feast pates for years. I ended up switching him over to a high protein kibble, and after 2 months on this food, he went from stage 3 to stage 1. Two months later, back for more testing and comes back early stage 1. Two months later (6mo at this point) and he no longer had any clinical signs of any kind. All blood work showing healthy kidneys, and he hadn't needed fluids or Ondansetron since his first 2mo checkup after the new food. I'll never feed another kidney cat low protein food again.

 

[Tim & Pookey]

I've had 4 kidney cats now, I've done rescue a long time. The first 3 I listened to the vets and fed the low protein they said I had to, to protect them. I watched them all wither away to nothing and it was awful. It wasn't until I spoke with the lady from Food Fur Life, that changed my way of thinking. She even showed me research saying low protein is good for no kitty, and we're only hurting them with those old myths.
I followed what she'd said with my 4th. He had been eating fancy feast pates for years. I ended up switching him over to a high protein kibble, and after 2 months on this food, he went from stage 3 to stage 1. Two months later, back for more testing and comes back early stage 1. Two months later (6mo at this point) and he no longer had any clinical signs of any kind. All blood work showing healthy kidneys, and he hadn't needed fluids or Ondansetron since his first 2mo checkup after the new food. I'll never feed another kidney cat low protein food again.

So interesting! Such a complicated disease, and animals in general. I have to imagine ECID applies here too.

 

[Holly and Sunny Bear]

Hey Holly, I'm going through something similar right now with the food and kidney values. Diabetes and CKD together makes it tough.

Sunny Bear's kidney values don't look crazy to me right now. Creatinine a little elevated from last year. Phosphorus OK. Was there a SDMA value in his recent labs?

In our case, what I decided was that I'd prioritize the diabetes for now with low-carb food. Take some load off his kidneys that way by trying to keep blood sugar regulated (anti-jinx). We're adding a good bit of water to his food to try to keep him hydrated too.

Dehydration and inflammation can impact the traditional kidney markers. Maybe some of that going on in your case. Might be worth checking labs again in a couple months to see where the kidney values are trending

Hey Holly, I'm going through something similar right now with the food and kidney values. Diabetes and CKD together makes it tough.

Sunny Bear's kidney values don't look crazy to me right now. Creatinine a little elevated from last year. Phosphorus OK. Was there a SDMA value in his recent labs?

In our case, what I decided was that I'd prioritize the diabetes for now with low-carb food. Take some load off his kidneys that way by trying to keep blood sugar regulated (anti-jinx). We're adding a good bit of water to his food to try to keep him hydrated too.

Dehydration and inflammation can impact the traditional kidney markers. Maybe some of that going on in your case. Might be worth checking labs again in a couple months to see where the kidney values are trending.

Thanks @Tim & Pookey - I just added his SDMA values to the labs. His previous 2 tests showed SDMA at 10 but this latest one from November is 14.
I do add water to his every meal as well. I'm wondering if his creatine and SDMA are going to come down over this month while he's on steroids and the new diet (RAWZ rabbit and pumpkin currently)....

 

[Jessica & Indy]

I had a cat with CKD and it is all about high quality protein. I also added fish oil to all of my cats' diets that really really helped. My 17.5 year old kitty now has no indications of CKD whatsoever. His bloodwork is beautiful in that regard. I have been using Smalls wet food since it is human grade and gently cooked (not raw).

 

[Holly and Sunny Bear]

While rabbit is typically the safest, pork is also considered very safe & tolerated but ibd cats with food allergies.
I don't know if you are buying, cooking, or get raw; but I do home cooked to make sure my 1 guy I have his with the worst issues isn't getting what he shouldn't. I know raw is best, but only 1 of mine had ever eaten the raw. I just buy Natural pork tenderloin from Smithfield I think. At my local Walmart, cause I can't afford local butchers. But I bake it in a pan with lots of water so when any nutrients that cook out (as well raw feeders complain about), create a healthy broth to serve with it. My cats like it shredded. I only have to add EZ Complete to it and it's perfectly balanced.
Why does your vet not want high protein? Is it from one of the other illnesses? High meat protein is all I've been taught, but mine don't have the other ailment yours does

Oh good to hear! thank you @Tyleete - maybe Sunny would be ok with pork! She is concerned about protein bc of his kidneys. The food he's on now (rawz rabbit and pumpkin) is too high in protein. i think it's 56% DMB...

 

[Tim & Pookey]

Thanks @Tim & Pookey - I just added his SDMA values to the labs. His previous 2 tests showed SDMA at 10 but this latest one from November is 14.
I do add water to his every meal as well. I'm wondering if his creatine and SDMA are going to come down over this month while he's on steroids and the new diet (RAWZ rabbit and pumpkin currently)....

Keep me posted! SDMA looks good too. IRIS guideline looks for <18 µg/dL.

 

[Holly and Sunny Bear]

I had a cat with CKD and it is all about high quality protein. I also added fish oil to all of my cats' diets that really really helped. My 17.5 year old kitty now has no indications of CKD whatsoever. His bloodwork is beautiful in that regard. I have been using Smalls wet food since it is human grade and gently cooked (not raw).

thanks for this idea! do you think the concern over high protein for ckd is outdated? I read that somewhere recently.... It sounds like your case pretty much proves that idea Smalls is a god idea. I will check that out.

 

[Holly and Sunny Bear]

Keep me posted! SDMA looks good too. IRIS guideline looks for <18 µg/dL.

thank you! I had no idea. I feel somewhat better now....

 

[Holly and Sunny Bear]

still not sure whether to get started on insulin again with his BGs being up again now.....or to wait and see if they come down over this month ?

 

[Tyleete]

thanks for this idea! do you think the concern over high protein for ckd is outdated? I read that somewhere recently.... It sounds like your case pretty much proves that idea Smalls is a god idea. I will check that out.

I can send you a bunch of info concerning old ways of thinking vs newer. Research is posted by actual vets. Let me know if you're interested in all the info I have on it. I saved it to show others that wanted.

 

[Holly and Sunny Bear]

So interesting! Such a complicated disease, and animals in general. I have to imagine ECID applies here too.

Wow!! That is incredible. I think you convinced me to stick with what he's on now. It's low carb high quality and good for his ibd. It's rawz rabbit and pumpkin. Thank you!!

 

[Holly and Sunny Bear]

I can send you a bunch of info concerning old ways of thinking vs newer. Research is posted by actual vets. Let me know if you're interested in all the info I have on it. I saved it to show others that wanted.

Yes when you have the chance. Thanks so much

 

[Wendy&Neko]

Sorry to hear Sunny is back in high numbers again.

The longer he stays in higher numbers, the harder to get a second remission. I wouldn't keep him on higher numbers for a month. It's OK to wait a few days to see if the new food makes a difference.

Neko was on budesonide, once started, for the rest of her life. Once they have IBD (or if small cell lymphoma), the steroid may be needed for much longer than 2-3 weeks. It can be tapered off eventually for SCL. My current kitty has both IBD and SCL. Sigh! She has to stay on a steroid, though a lower dose than when she started it over 7 years ago. Every IBD kitty is different in what they need. Some just need it periodically. All three of my GI kitties were vomiters, not diarrhea. It depends what part of the intestine the disease is most prevalent.

Is the budesonide pills or compounded liquid? Compounded liquids somethings have sugar in them. Budesonide did not impact Neko's BG numbers, but it does for some cats.

Regarding kidney values, his Creatinine shows stage 2 CKD, but I don't see any urinalysis. Has he had a urine specific gravity done lately? If not, you can capture a first thing in the morning pee and take it into the vets for analysis. A USG is a sign of urine concentration and is best represented by morning pee. Kidney values can be higher if they are dehydrated at the time of the blood draw. Looking at the SDMA, I notice that Idexx says normal is up to 14, not 18. I also am not a fan of SDMA, nor is my vet. In 2017 I had a cat show SDMA of 14 (early kidney disease), two years later same cat had SDMA of 5. And has been otherwise around 8 until recently.

If you haven't been there already, check out: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease – Everything You Need to Know to Help Your Cat. The section on food talks about the need for higher quality protein in the early stages, with links to papers.

 

[Holly and Sunny Bear]

Sorry to hear Sunny is back in high numbers again.

The longer he stays in higher numbers, the harder to get a second remission. I wouldn't keep him on higher numbers for a month. It's OK to wait a few days to see if the new food makes a difference.

Neko was on budesonide, once started, for the rest of her life. Once they have IBD (or if small cell lymphoma), the steroid may be needed for much longer than 2-3 weeks. It can be tapered off eventually for SCL. My current kitty has both IBD and SCL. Sigh! She has to stay on a steroid, though a lower dose than when she started it over 7 years ago. Every IBD kitty is different in what they need. Some just need it periodically. All three of my GI kitties were vomiters, not diarrhea. It depends what part of the intestine the disease is most prevalent.

Is the budesonide pills or compounded liquid? Compounded liquids somethings have sugar in them. Budesonide did not impact Neko's BG numbers, but it does for some cats.

Regarding kidney values, his Creatinine shows stage 2 CKD, but I don't see any urinalysis. Has he had a urine specific gravity done lately? If not, you can capture a first thing in the morning pee and take it into the vets for analysis. A USG is a sign of urine concentration and is best represented by morning pee. Kidney values can be higher if they are dehydrated at the time of the blood draw. Looking at the SDMA, I notice that Idexx says normal is up to 14, not 18. I also am not a fan of SDMA, nor is my vet. In 2017 I had a cat show SDMA of 14 (early kidney disease), two years later same cat had SDMA of 5. And has been otherwise around 8 until recently.

If you haven't been there already, check out: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease – Everything You Need to Know to Help Your Cat. The section on food talks about the need for higher quality protein in the early stages, with links to papers.

His budesonide is compounded in capsules. I'll check with the pharmacy to ask about added sugar. I'll also try to get urine from him tomorrow and bring it ìn. It's been awhile since he's had a proper UA. Thanks for the info @Wendy&Neko