2/20 - Gen, AMPS 239, PMPS 84 - diet input needed re: vet advice!

[Allie & Gen]

Yesterday

Good morning and happy Friday, folks! I hope it's a smooth day for you all, and a safe surf for your kitties.

I'm still pretty exhausted, but relieved to have Gen back on a Libre and his full current dose. Poor boy was clearly struggling with some constipation this morning, so I'll probably up his Miralax again tonight (I seem to just have to adjust the dosage up and down responsively based on how he's pooping on a given day). Yesterday I checked in with my vet's office, but apparently they don't have the full results from the ultrasound back from the lab yet; fingers crossed that they get them today.

Because of all the chaos, I haven't set up Gen's new autofeeder yet. Will do that tonight.

 

[Allie & Gen]

Gen keeping me on my toes with another long run of low greens (please hang in there, Libre, I do not want to have to go through another installation this week). He really seems to like 53/54; he's spent the majority of the last few hours there, with a few tiny bumps up into the lower 60s. It's a little anxiety-inducing when I'm at the office, definitely makes focus even harder than it already is, but I'm glad he's in the greens. I'd probably be happiest if he were flatter and just a smidge higher, but we can't have everything ... can work on the first part, at least! Not too sure about the second part, though.

 

[Jessica & Indy]

Come on Gen!!!! You got this buddy!

 

[Allie & Gen]

Jeez, we're at +9 and he's not coming up at all. And from what I can tell via the pet cam, he doesn't have much food leftover (so he's not going to spike himself up with it) - though right now his normal mealtime is a good 45 minutes prior to shot time as I work on gradually moving it back, so that might change things a bunch.

BUT. I just heard back from my vet with test results!

First of all, we finally heard back about the insulin-like growth hormone, and it was negative. So no acromegaly! (As I thought, but still, it's a relief.)

Secondly, confirmation re: pancreatitis and IBD/enteropathy. These are my vet's suggested next steps:

1 - Start vitamin B12 (either injection or oral)
2 - Test fructosamine (partly to validate the Libre numbers/double check on current insulin dosing)
3 - Change to therapeutic prescription diet.

It's #3 that I could use some advice on, unsurprisingly.

We all know that prescription food is suspect on a few levels, and it's all higher-carb than we want for our diabetic cats. The last part, at least, my vet understands as well and acknowledges, but she feels strongly that for now, it's a trade-off we have to make.

Here are some relevant excerpts from her email:

[internal med specialist] also recommended a prescription therapeutic GI diet trial - either Science Diet Biome, a novel protein diet like Royal Canin Select Protein Rabbit, or a hypoallergenic diet like SD z/d or Royal Canin HP. I know that these aren't ideal when taking his diabetes into consideration, but at this phase of the game, if we don't get his GI signs under control, I fear we will still struggle to regulate his diabetes and also struggle to get him stable enough for his dental procedure. She also recommended keeping the diet and amount static for at least 4-6 weeks without the addition of other supplements like fiber so we can get a clear picture of his response to therapy.

and:

I know you're hesitant to do this [change to a therapeutic prescription diet], but I need you to put faith in me (and [internal medicine specialist]) that this is the right call for Gen. There are no good hypoallergenic OTC diets, considering the severity of Gen's symptoms, and the fact that research has been done to show that significant cross-contamination exists.

I could use some input, please, especially from folks who specifically have experience with diabetes and IBD (and pancreatitis). Which I know many of you do.

I wrote back with a list of brands that could potentially be low-carb novel protein options: Smalls, Rawz, Rayne, Identity, Hounds & Gatos, Koha, Ziwi Peak. I also asked her about this research into cross-contamination that she references. (That very definitely got my attention.)

My vet is no slouch, and she's not just making these recommendations out of ease or familiarity or disregard for my concerns. She is taking everything into account. I trust her expertise and her judgement (and she listens to me). I hate to think of going back on Gen's recent progress with BG, but I need to care for him as a whole cat, and I definitely think that sometimes there have to be trade-offs, at least in the short term. (See also: dental surgery for an unregulated diabetic cat, with a therefore somewhat elevated risk with regard to anesthesia.)

(One thing I can't forget: Gen was on a 13% carb prescription wet food, and the corresponding prescription dry food, when he went into remission in 2021 and for years after. Putting him back on a medium-carb prescription food for a trial period seems unlikely to send his BG into the stratosphere permanently. Specific carb count is not necessarily an absolute prerequisite for regulation, though obviously it is key for many, and probably most, cats.)

But that said ... I know many of you manage these conditions together, and do it without making that kind of trade-off. (Which I don't think means it's necessarily not the best choice for him in the short term/on a trial basis! But I want to have as complete a picture as I can.)

Sorry for the wall of text. Thank you as always for your care and support.

 

[Tim & Pookey]

Interesting about cross contamination, haven’t heard of that before with otc novel proteins.

@JoM has pancreatitis experience, if you haven’t connected yet.

 

[Jessica & Indy]

I have had to deal with Indy and his IBD for over 10 years. We do vitamin B12 injections. After it is built up in his system he only needs it once a month which isn't bad.

Raw/gently cooked diets are a really good way to go for IBD. I don't quite trust raw so I went with smalls. It doesn't have a bunch of added extra stuff and Indy loves it. Their pig recipe is his favorite. But that kind of diet easily eliminates stuff that can aggravate the IBD.

He is on a super low dose of chlorambucil once a week (he became diabetic the first time because he had been on prednisolone for 8ish years). I also have him on a highly concentrated fish oil and fiber supplement. With the exception of the FF fiasco, he hasn't had a flare up in years.

Hope you find a diet that works for him. <3

 

[JoM]

Karamelle has done really well on the Young Again Mature Zero LID dry. Its Hydrolyzed Pork Protein. I added a little Dr. Elseys as well which has Chicken & Hydrolyzed Pork. She does not have IBD however. Just Pancreatitis and Diabetes. We also started B12 injections because the GI panel showed really low B12. I know you probably want to feed wet food. Karamelle is a dry food girl so I dont argue. She eats some weruva hydrated pates occasionally.

 

[squeem3]

Good info here:

IBDKitties – Helping Save Lives…One Paw at a Time
Feline IBD - Healing can happen!

The only novel protein Smalls has is pork. There is a turkey but many IBD cats can't eat that.

Savage Raw has a cooked option in rabbit/lamb.

@Staci & Ivy does a home cooked diet with a pre-mix.

Raw diets obviously can't be left in a feeder although the Pet Libro feeder might be ok since it has a cooling feature. Since Gen is a grazer it's best to just put canned into the feeder to avoid potential tummy issues with left out raw.

Leroy is fed a commercial freeze dried raw diet in rabbit. I put Koha LID rabbit into the feeder. It took awhile of trying different novel proteins and brands of raw to see what worked with his IBD. Pork and beef and all poultry / birds were no-gos. Primal was too veggie heavy and resulted in super stinky I could smell getting off the elevator and I have to go around 2 corners and down two halls to get to my door. We eventually settled on Vital Essentials freeze dried raw. Does the food work? Well, it's Leroy He still gets pancreatits and bgs are mostly yellow no thanks to the budesonide which seems to be working on the IBD and the asthma.

Injectable B12 is easy to do. Leroy only gets it once a month but other cats may need it more frequently.

 

[Marje and Gracie]

Jeez, we're at +9 and he's not coming up at all. And from what I can tell via the pet cam, he doesn't have much food leftover (so he's not going to spike himself up with it) - though right now his normal mealtime is a good 45 minutes prior to shot time as I work on gradually moving it back, so that might change things a bunch.

BUT. I just heard back from my vet with test results!

First of all, we finally heard back about the insulin-like growth hormone, and it was negative. So no acromegaly! (As I thought, but still, it's a relief.)

Secondly, confirmation re: pancreatitis and IBD/enteropathy. These are my vet's suggested next steps:

1 - Start vitamin B12 (either injection or oral)
2 - Test fructosamine (partly to validate the Libre numbers/double check on current insulin dosing)
3 - Change to therapeutic prescription diet.

It's #3 that I could use some advice on, unsurprisingly.

We all know that prescription food is suspect on a few levels, and it's all higher-carb than we want for our diabetic cats. The last part, at least, my vet understands as well and acknowledges, but she feels strongly that for now, it's a trade-off we have to make.

Here are some relevant excerpts from her email:


and:


I could use some input, please, especially from folks who specifically have experience with diabetes and IBD (and pancreatitis). Which I know many of you do.

I wrote back with a list of brands that could potentially be low-carb novel protein options: Smalls, Rawz, Rayne, Identity, Hounds & Gatos, Koha, Ziwi Peak. I also asked her about this research into cross-contamination that she references. (That very definitely got my attention.)

My vet is no slouch, and she's not just making these recommendations out of ease or familiarity or disregard for my concerns. She is taking everything into account. I trust her expertise and her judgement (and she listens to me). I hate to think of going back on Gen's recent progress with BG, but I need to care for him as a whole cat, and I definitely think that sometimes there have to be trade-offs, at least in the short term. (See also: dental surgery for an unregulated diabetic cat, with a therefore somewhat elevated risk with regard to anesthesia.)

(One thing I can't forget: Gen was on a 13% carb prescription wet food, and the corresponding prescription dry food, when he went into remission in 2021 and for years after. Putting him back on a medium-carb prescription food for a trial period seems unlikely to send his BG into the stratosphere permanently. Specific carb count is not necessarily an absolute prerequisite for regulation, though obviously it is key for many, and probably most, cats.)

But that said ... I know many of you manage these conditions together, and do it without making that kind of trade-off. (Which I don't think means it's necessarily not the best choice for him in the short term/on a trial basis! But I want to have as complete a picture as I can.)

Sorry for the wall of text. Thank you as always for your care and support.

I’m rather behind but how did she diagnose IBD because the only way to diagnose it is through a biopsy. They can look at an ultrasound and see whether the intestines are thickened or not but he has to have a biopsy (via endoscopy) to really diagnose it and be sure there is no small cell lymphoma.

My civvie Tobey has shown thickened intestines on ultrasounds for over five years. Interestingly, it never has changed and we haven’t done a biopsy because he’s older and he has a heart condition so anesthesia is risky for him. He’s on a homemade raw diet using Food Fur Life. The prescription low residue diets are really poor ingredients and some of them have a higher % of calories from carbs. Not sure what the one is you are looking at.

BUT.....I’ve been able to keep him and his weight very stable through all of that AND he now is Stage 3 CKD plus he was hyperthyroid, had I131 which made him hypothyroid so he’s on thyroid meds. I use several Adored Beast products like Felix’s Flora, Healthy Gut, Gut Soothe, plus a big one and very important is Jarrows Saccharomyces boulardi with MOS. I also give him NOW slippery elm powder with George’s distilled aloe vera (this is the ONLY brand that is non toxic to cats). He also gets some other things but most of the above is what I use to treat his IBD.

Did your vet do a GI Panel through Texas A&M to determine his cobalamin is low? While I give Tobey methylB12 and a multi B for his CKD (his GI Panel was normal), the B12 your vet would give would be cyanocobalamin.

If you are on FB, there is a great group there called “Raw Feeding for IBD Cats”. You don’t have to feed raw to join; many don’t. But there are some great resources there as well as on ibdkitties.net.

Let me know if you have any questions.

 

[Allie & Gen]

Okay, to be clear, the diagnosis of IBD is not 100% - it's based on ultrasound findings (thickened intestines, mildly enlarged abdominal lymph nodes, dilation of the intestinal wall lymph system) and clincal signs. (Fluctuating constipation/diarrhea, inappetence/nausea). I'm using IBD as a shorthand - she generally says "IBD/enteropathy."

My vet takes my very shaky finances into account when it comes to her recommendations, which is likely why she hasn't suggested a biopsy; likewise, she did provide the option of a fasted GI panel, but suggested that it wouldn't hurt to simply go ahead and try him on B12 shots. I think in general, she wants to move to treatment with some urgency. For one thing, he has a very overdue dental procedure that had to be postponed because the GI issues were serious enough that she was too concerned about anesthesia without having them under control.

For the diet trial, the recommendations I received from the internal medicine specialist my vet works with are:

either Science Diet Biome, a novel protein diet like Royal Canin Select Protein Rabbit, or a hypoallergenic diet like SD z/d or Royal Canin HP

As noted above, I am aware of the problems with so-called prescription foods, and she is aware of my concerns. From the email, it sounds as though she thinks the apparent likelihood of cross-contamination in other brands is a bigger immediate concern than the carb content in the prescription food, for the purposes of the food trial at least.

I really would like to know more about the research she referred to re: cross-contamination.

Right now, I'm just looking at doing a food trial - no dietary supplements or additional medications (apart from the B12) just yet. I also am not keen on raw food. For now, my dilemma is mostly just this: for the duration of a food trial (after which we can reconsider), go with the vet/specialist dietary recommendations, or try to find a low-carb alternative that satisfies the same requirements?

 

[Seth&Bell]

Good to hear about the negative on acromegaly, Allie

 

[Allie & Gen]

On an unrelated-to-diet-questions note: another green preshot, and this time I went with the full (well, just slightly skinny) dose! I'm a bit nervous, but at least I'm going to be home (if hopefully asleep, eventually) ...

 

[Marje and Gracie]

Okay, to be clear, the diagnosis of IBD is not 100% - it's based on ultrasound findings (thickened intestines, mildly enlarged abdominal lymph nodes, dilation of the intestinal wall lymph system) and clincal signs. (Fluctuating constipation/diarrhea, inappetence/nausea). I'm using IBD as a shorthand - she generally says "IBD/enteropathy."

My vet takes my very shaky finances into account when it comes to her recommendations, which is likely why she hasn't suggested a biopsy; likewise, she did provide the option of a fasted GI panel, but suggested that it wouldn't hurt to simply go ahead and try him on B12 shots. I think in general, she wants to move to treatment with some urgency. For one thing, he has a very overdue dental procedure that had to be postponed because the GI issues were serious enough that she was too concerned about anesthesia without having them under control.

For the diet trial, the recommendations I received from the internal medicine specialist my vet works with are:



As noted above, I am aware of the problems with so-called prescription foods, and she is aware of my concerns. From the email, it sounds as though she thinks the apparent likelihood of cross-contamination in other brands is a bigger immediate concern than the carb content in the prescription food, for the purposes of the food trial at least.

I really would like to know more about the research she referred to re: cross-contamination.

Right now, I'm just looking at doing a food trial - no dietary supplements or additional medications (apart from the B12) just yet. I also am not keen on raw food. For now, my dilemma is mostly just this: for the duration of a food trial (after which we can reconsider), go with the vet/specialist dietary recommendations, or try to find a low-carb alternative that satisfies the same requirements?

My concern with enlarged lymph nodes would be intestinal lymphoma. I took Tobey to see an oncologist just for the info and she said with lymphoma, the hallmark sign is weight loss.

I’m afraid I can’t be much help on prescription or commercial diets. I am in the camp that believes they are often why our cats get IBD and/or lymphoma and other cancers.

 

[Allie & Gen]

My concern with enlarged lymph nodes would be intestinal lymphoma. I took Tobey to see an oncologist just for the info and she said with lymphoma, the hallmark sign is weight loss.

Yikes. I'll ask about that.

Gen lost weight both times he was diagnosed with diabetes, so it's a bit tricky to tell. He's recently been gaining weight - something I've been deliberately working via his daily caloric intake.

 

[Allie & Gen]

Rayne appears to have "prescription" diet options that are significantly lower in carbs than Hill's or Royal Canin (and also more affordable). I wonder.

 

[Albert & Xander]

No advice I can offer but glad you heard back from the vet and have somewhat of a plan.
Good luck with the autofeeder! That should make things a lot easier and consistent with food timing.

 

[Wendy&Neko]

Great news on the acromegaly, but I think I told you it was unlikely. Too bad you spent money on that test but now you can put that worry to rest.

Okay, to be clear, the diagnosis of IBD is not 100% - it's based on ultrasound findings (thickened intestines, mildly enlarged abdominal lymph nodes, dilation of the intestinal wall lymph system) and clincal signs. (Fluctuating constipation/diarrhea, inappetence/nausea). I'm using IBD as a shorthand - she generally says "IBD/enteropathy."

IBD is the same as enteropathy. The elephant in the room not talked about is small cell lymphoma. You cannot differentiate between IBD and small cell lymphoma without a biopsy. The treatments are different between the two conditions. Small cell lymphoma does not need a special novel protein diet, and IBD does - just one example of the differences. Don't let the SCL phrase worry you too much. With proper treatment something like 90% go into remission. The furry in my house was diagnosed in 2018 with IBD and SCL, hasn't been on any meds for SCL for a few years now. But still has IBD. I find that one harder to deal with.

for the duration of a food trial (after which we can reconsider), go with the vet/specialist dietary recommendations, or try to find a low-carb alternative that satisfies the same requirements?

Go with the low carb alternative.

I too would suggest a test for low B12 before supplementing. Though many IBD or SCL cats are low in it, the two of my SCL cats I've tested were not. Check out this page Vitamin B – Tanya's Comprehensive Guide to Feline Chronic Kidney Disease near the bottom on the section of Vitamin B12 cautions, and the section on Vitamin B12 and cancer specifically. The section following is on B12 and diabetics.

 

[Allie & Gen]

Great news on the acromegaly, but I think I told you it was unlikely. Too bad you spent money on that test but now you can put that worry to rest.

I thought it was unlikely too, but I'm not sorry to be able to rule it out.

IBD is the same as enteropathy. The elephant in the room not talked about is small cell lymphoma. You cannot differentiate between IBD and small cell lymphoma without a biopsy. The treatments are different between the two conditions. Small cell lymphoma does not need a special novel protein diet, and IBD does - just one example of the differences. Don't let the SCL phrase worry you too much. With proper treatment something like 90% go into remission. The furry in my house was diagnosed in 2018 with IBD and SCL, hasn't been on any meds for SCL for a few years now. But still has IBD. I find that one harder to deal with.

(I think enteropathy is a broader term which encompasses IBD and some related conditions? But that's splitting hairs.) As far as SCL goes, I have written my vet to ask about it and why we haven't been discussing it already. (I'm surprised it hasn't come up here before either, given the similar symptoms.) I'm worried about the prospect of doing a biopsy with her grave concerns about anesthesia while he has these unmanaged issues (GI and diabetes) ... and I note that treatment for SCL involves steroids, which, yikes. But I've been glad to see that the prognosis tends to be favorable, at least, if that should be the issue here.

Go with the low carb alternative.

Not sure I've found one that will meet her criteria if cross-contamination is such a big concern, but I think I've at least found medium carb options, which might have to suffice.

I too would suggest a test for low B12 before supplementing. Though many IBD or SCL cats are low in it, the two of my SCL cats I've tested were not. Check out this page Vitamin B – Tanya's Comprehensive Guide to Feline Chronic Kidney Disease near the bottom on the section of Vitamin B12 cautions, and the section on Vitamin B12 and cancer specifically. The section following is on B12 and diabetics.

Thank you! Definitely some food for thought there. I don't love the idea of having to wait on a fasted GI panel in addition to everything else, but I'm also not sure if that's the only way to determine a B12 deficiency. Something to look into tomorrow ... I need to sleep, if Gen will let me. (Yaaay, all these blues and greens ... )

Grateful for all your input, as always.