Help for my little guy that is a mess

[OlliesArmyof1]

Hey everyone,

I'm not sure if I am in the right place or not, but I'm a bit desperate and am hoping someone can show me in the right direction if possible. In short, I need help finding a (sadly) DRY food for my little guy with a ton of health issues. I've desperately tried to get him onto wet food for years, trying all of the tricks, and he absolutely refuses. He is also extremely picky about switching food as well, but it is doable over a month or so.

Background on Oliver:

He has had chronic recurring pancreatitis for several years. We scoped him in October 2018 after a severe bout, and he was diagnosed with small cell lymphoma. He is currently on nausea meds, an appetite stimulant, a low dose of steroid, and chlorambucil (chemo med) for these issues. At his appointment today, his values for pancreatitis still indicate a chronic inflammation issue.

In the past month he has been diagnosed as diabetic. We believe the combo of the pancreatitis and the steroid has meant he now needs insulin. We are continuing to try and reduce his steroid dose so he doesn't need the insulin, but no one can be sure if he will be able to come off of the insulin or not in the future. His numbers aren't super high, usually in the mid 200s fasting, so it isn't awful yet. The highest number we got during out first curve we did this weekend was in the 320s.

Then, at his monthly appointment today, they are telling me that his kidney values are a bit elevated, and that we should consider a "low protein" diet. My research tells me this is incorrect, and I should maybe be looking for lower phosphorus. It looks like his urea nitrogen is 45, and BUN/Creatinine ratio is 45. His calcium is also a little high at 12.6 (he has had slightly high or on the high end of normal for awhile now).

I love my little guy very much. He has been a trooper through all of this. He has had some rough days, but is generally still in good spirits. He has slowed down a bit, but still seeks out my husband and I for lap time, catches bugs in the house, and manages to get into trouble. I want to try and continue helping him for as long as he tells me he wants to continue going on, but I'm at a loss as to the diet thing. Him refusing wet food does not help. I've even tried moistening his dry food slightly, and he does not show much interest. I know I will not find a diet that is perfect because of this, but if someone could help guide me to how to find a diet that is decently ok for his many issues, I would be forever grateful.

 

[Veronica & Babu-chiri]

Sorry to hear about all his issues but hang in there!!

What are his creatinine and phosphorus values? Has te vet made a ionised calcium level test?

Pancreatitis may be the cause of his high creatinine values

Are you giving subcutaneous liquids (subq's) ? Usually those are recommended when creatinine values are over 3.5 but in your case giving subq's could help with the pancreatitis and to lower his calcium levels a bit

There's a bunch of issues that you will have to address, you do need a low carb diet to help with his diabetes and it also needs to be low phosphorus to help with the kidneys ( and avoid complications because of his high calcium levels) and preferably low in fat to help his pancreatitis, you should be careful about the "prescription" kidney diets the low protein ones because they are way high in carbs and a lot of times a bit high in calcium (they focus on low phosphorus not low calcium), .

There's a list of wet food that you may try where you could find one that he likes if you can convince him to switch to wet, here's the link http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Some people give a dry food called Young again cero carbs it is low carb so if he tolerates it at least it will help his diabetes, I'm not sure if it is available where you live but maybe you could give it a try

I'm not sure there's one specific food that could cover all the issues but have you tried or thought about home cooking or raw ? That way you may be able to control all his requirements a bit better.

There's a web page where you can find a lot of very good information regarding CKD (cronic kidney desease) and it has also some very good suggestions about pancreatis this is the link http://www.felinecrf.org/pancreatitis.htm

 

[MrWorfMen's Mom]

Welcome to FDMB. So glad you found us but sorry you had to. You definitely have a difficult situation on your hands with multiple health issues to contend with. We're here to help as best we can and there are many members here dealing with pancreatitis, lymphoma, kidney issues along with diabetes so you are not alone.

It sounds like the kidney issues are still in the early stages so I agree with your assessment that a low phosphorus rather than low protein diet would be best. I can relate totally to the dry food addicted cat. My extra sweet girl refused to eat anything that didn't crunch from kittenhood till about 2 years into our diabetes journey. I tried every trick in the book and a few very smelly experiments trying to make dehydrated wet food (not recommended without a gas mask! ). My girl finally relented one day when I guess her hunger got the better of her and Mom wasn't being co-operative about topping up her bowl. I caught her pilfering her brother's left over wet food and took that opportunity to stop the dry food. It seems it had to be her idea to eat the wet food.....not mine. I know only too well how frustrating it is to want to switch their food and have them turn their noses up at every offering. Alas they have to eat but don't give up hope of being able to switch.....your little fella may just surprise you one day too.

So given the different medical issues you are dealing with, it looks to me like Young Again would be your best bet with Dr. Elsey's being your second best option. Both are low carb and Young Again is low in phosphorus and the Dr. Elsey is a bit higher but not seriously high. Young Again is only available online. Both company's will send samples so you don't have to invest a fortune to find out kitty isn't interested.

There is a list of dry foods and their analysis here on Tanya's CRF site.
http://www.felinecrf.org/dry_food_usa.htm

I am by no means an expert on CRF or pancreatitis but hopefully others will chime in with more suggestions. Please keep the questions coming. We're here to help even if all you need is a place to let off some steam!

 

[OlliesArmyof1]

Sorry to hear about all his issues but hang in there!!

What are his creatinine and phosphorus values? Has te vet made a ionised calcium level test?

Pancreatitis may be the cause of his high creatinine values

Are you giving subcutaneous liquids (subq's) ? Usually those are recommended when creatinine values are over 3.5 but in your case giving subq's could help with the pancreatitis and to lower his calcium levels a bit

There's a bunch of issues that you will have to address, you do need a low carb diet to help with his diabetes and it also needs to be low phosphorus to help with the kidneys ( and avoid complications because of his high calcium levels) and preferably low in fat to help his pancreatitis, you should be careful about the "prescription" kidney diets the low protein ones because they are way high in carbs and a lot of times a bit high in calcium (they focus on low phosphorus not low calcium), .

There's a list of wet food that you may try where you could find one that he likes if you can convince him to switch to wet, here's the link http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Some people give a dry food called Young again cero carbs it is low carb so if he tolerates it at least it will help his diabetes, I'm not sure if it is available where you live but maybe you could give it a try

I'm not sure there's one specific food that could cover all the issues but have you tried or thought about home cooking or raw ? That way you may be able to control all his requirements a bit better.

There's a web page where you can find a lot of very good information regarding CKD (cronic kidney desease) and it has also some very good suggestions about pancreatis this is the link http://www.felinecrf.org/pancreatitis.htm

Hello! Yes, we have checked his ionized calcium and done a malignancy panel as well. They decided about a year ago that it seemed to be idiopathic. I checked his bloodwork, his creatinine today was 1.0, and phosphorus 7.8. Those don't seem to be outside the reference range like the other numbers I listed above, what does that mean? I would be totally happy to switch him to home cooked or raw if he would eat it. I've tried fully cooked chicken, raw chicken, raw turkey, and then partially cooked chicken thighs with no interest. The only things other than dry kibble that he will eat are cows milk (which he isn't allowed anymore), and high calorie nutritional paste (which he also isn't allowed because it is basically all sugar).

Have people had good luck with the young again zero carb?

 

[Veronica & Babu-chiri]

his creatinine today was 1.0, and phosphorus 7.8. Those don't seem to be outside the reference range like the other numbers I listed above, what does that mean? I

Well a creatinine value of 1.0 means his kidney function is still ok but given the other numbers he's at risk for CKD but not there yet which is good news, because you can focus more on getting the pancreatitis and diabetes under control, still his phosphorus value is a bit high so focusing on a low phosphorus diet will certainly help

And yes for what I've heard people using Young again have had good results, can't talk from personal experience since it is not available where I live

 

[FurBabiesMama]

A lot of people have run into issues with runny poop/diarrhea when feeding Young Again. I initially fed it to my girls when starting the conversion to wet food and thought we were going to dodge the bullet on the poop issues, but then I got a new bag, and the poops issues started... and I was just giving them a tiny bit as a food topper, so I cannot imagine how bad it would have been if I had been feeding it to them as their meals. So, if you try it, and don't see poop issues, just don't be surprised if somewhere along the way you get a bag that causes issues. I switched to Dr Elsey's Clean Protein Chicken after that and had no further issues.

I understand how difficult it can be to transition to wet food. It took SEVERAL wet foods before I found any that my girls would eat much of. I started making chicken bone broth and adding that to their food as well as some water and always microwaving it several seconds to warm it up. I had to use dry food as a topper for Mia's wet food for many, many months before I could get her to eat wet food without it, and even now, she still won't touch her wet food until I sprinkle some crumbled PureBites freeze dried chicken on top. I think she has a texture issue... after eating dry her entire life, she thinks food should crunch. My girls have been dry food free for months now. It required persistence and patience, but the conversion to wet was possible!

 

[OlliesArmyof1]

So given the different medical issues you are dealing with, it looks to me like Young Again would be your best bet with Dr. Elsey's being your second best option. Both are low carb and Young Again is low in phosphorus and the Dr. Elsey is a bit higher but not seriously high. Young Again is only available online. Both company's will send samples so you don't have to invest a fortune to find out kitty isn't interested.

There is a list of dry foods and their analysis here on Tanya's CRF site.
http://www.felinecrf.org/dry_food_usa.htm

I am by no means an expert on CRF or pancreatitis but hopefully others will chime in with more suggestions. Please keep the questions coming. We're here to help even if all you need is a place to let off some steam!

I'm actually really surprised, I think that according to that website, the phosphorus content of my cat's current food (Natural Balance Duck and Green Pea at 1.03 phosphorus) versus 1.08 for Dr. Elsey's clean chicken. The carbs though are way higher. Would the increased phosphorus be more detrimental than the carbs? This is definitely so confusing!!

I'm going to keep trying on the wet food, I just am not sure of the logistics of it. Both my husband and I work all day (about 8-5), so I can't be home to put down and take up food. I worry about putting down food he doesn't like, giving him insulin, and then having him go hypo because he won't eat. How do you all handle that?

 

[OlliesArmyof1]

I posted this as a reply above, but I'm not sure if many people will see it. I was curious, how do you guys deal with picky eaters?

My husband and I work from 8-5 everyday, so I worry about putting out food Oliver won't eat, giving him insulin, and then having him go hypoglycemic during the day because he hasn't eaten. Any tips for dealing with that?

It is so frustrating, he absolutely doesn't even see wet food as food at all. I was able to get him to nibble a little at his dry food, moistened slightly, but other than that, he sniffs and then stares at me blankly. I've also offered different meats of people food, and tried various states of chicken both cooked, uncooked, and partially cooked. I've offered about 2 dozen different wet foods.

 

[OlliesArmyof1]

A lot of people have run into issues with runny poop/diarrhea when feeding Young Again. I initially fed it to my girls when starting the conversion to wet food and thought we were going to dodge the bullet on the poop issues, but then I got a new bag, and the poops issues started... and I was just giving them a tiny bit as a food topper, so I cannot imagine how bad it would have been if I had been feeding it to them as their meals. So, if you try it, and don't see poop issues, just don't be surprised if somewhere along the way you get a bag that causes issues. I switched to Dr Elsey's Clean Protein Chicken after that and had no further issues.

I understand how difficult it can be to transition to wet food. It took SEVERAL wet foods before I found any that my girls would eat much of. I started making chicken bone broth and adding that to their food as well as some water and always microwaving it several seconds to warm it up. I had to use dry food as a topper for Mia's wet food for many, many months before I could get her to eat wet food without it, and even now, she still won't touch her wet food until I sprinkle some crumbled PureBites freeze dried chicken on top. I think she has a texture issue... after eating dry her entire life, she thinks food should crunch. My girls have been dry food free for months now. It required persistence and patience, but the conversion to wet was possible!

Yikes about the diarrhea, he already has issues with that on and off because of his GI lymphoma. They have actually firmed up a bit since starting insulin, though.

Did you add the chicken bone broth to the dry kibble?

 

[MrWorfMen's Mom]

I went through that conundrum with my girl re: will she eat what I left out for her. She too didn't seem to understand that wet food was edible. She tried to bury any of my wet food offerings as well as her brother's wet food. I have scratch marks on my kitchen wall attesting to her trying to bury wet food as if it were her waste. Having 2 other kitties, I had to deal with wondering if there would be food available for my sugar girl if she needed it. My solution was to opt to make sure I left something out I knew she would eat when I wasn't going to be home to monitor and initially I left far more out than I needed to just for safety sake in case the boys got extra hungry. After some experimenting, I finally found a good middle ground that seemed to keep everyone happy and safe. I really think our kitties are all unique personalities and while we can make suggestions, you just have to brainstorm based on what you know about your kitty to find what will work.

Since it seems that the kidney function is borderline at this point, I think I would opt to keep the carbs down and try to get the diabetes under control as that too can cause kidney issues and hasten kidney damage. Others may have a different perspective on that.

In the big scheme of things, your cat is in control of this situation. Kitty has to eat not only for nutrition but also so insulin can be given and BG kept at safe levels. Insulin dosage can be adjusted as needed but a kitty not eating is a recipe for any number of problems.

Not to make light of the situation (I know all too well how frustrating it can be) but keeping a sense of humour helps. My girl despite her hatred for soft food, tried to eat a peanut butter sandwich when my back was turned one day. If you need a good giggle read this..... http://www.felinediabetes.com/FDMB/threads/the-peanut-butter-sandwich.144524/#post-1498882.

 

[Panic]

I posted this as a reply above, but I'm not sure if many people will see it. I was curious, how do you guys deal with picky eaters?

My husband and I work from 8-5 everyday, so I worry about putting out food Oliver won't eat, giving him insulin, and then having him go hypoglycemic during the day because he hasn't eaten. Any tips for dealing with that?

My mom's tomcat is the most stubborn cat I've ever met when it comes to his dry food. Won't eat ANYTHING else, not table scraps or bits of meat or chicken broth, ONLY his dry. Wet food was a -hah- luxury to the kitties in my household, so I'd buy them wet to eat once a week, everyone loved it except him. My cats are now wet-only but the others are still on dry but I try to share the wet with them daily. Mom's tomcat hates it but after several weeks if I cover the wet in dry food sometimes he'll finish it. Patience and diligence, I guess. Some people warm it up just a bit to make it extra smelly and "mouse-temperature".

For the food situation away from home, most of us use auto-feeders! Petsafe 5 Auto Feeder is the leading favorite, it's about $50 on Amazon but I snagged a used one on Ebay a couple weeks ago for $20. As far as I know, it's the only one that lets you freely customize what time you wish to feed. I bought a Cat Mate C50 on Ebay for cheap as well only to realize I couldn't time it an hour out, only 6 hours, so keep that in mind when considering one.

 

[Veronica & Babu-chiri]

I'm actually really surprised, I think that according to that website, the phosphorus content of my cat's current food (Natural Balance Duck and Green Pea at 1.03 phosphorus) versus 1.08 for Dr. Elsey's clean chicken. The carbs though are way higher. Would the increased phosphorus be more detrimental than the carbs? This is definitely so confusing!!

I'm sorry to say that given her diabetes and the high level of calcium and phosphorus that she has (if only one of them was high things would be a little bit less complicated) I think you need to address both things, high carbs is going to affect his diabetes which as you now can become very complicated and make her feel really bad and high phosphorus can make her have low appetite, loose weight, have nausea, stomach acid and also in combination with the high calcium can damage some organs especially the kidneys

So you do need to find a low phosphorus low carb food that he likes but since the most important thing is that she eats you could also consider giving her the food that she likes (as long as is low carb no way around that) and a phosphorus binder this is a link with a lot of information about phosphorus binders (http://www.felinecrf.org/phosphorus_binders.htm)

I'm going to keep trying on the wet food, I just am not sure of the logistics of it. Both my husband and I work all day (about 8-5), so I can't be home to put down and take up food. I worry about putting down food he doesn't like, giving him insulin, and then having him go hypo because he won't eat. How do you all handle that?

I use a timed auto feeder, actually the comercial wet food will last for a few hours out before anything happens, but if is warm weather or I know there are going to be a lot of hours what I do is I freeze a bit of the food in advance and place it on the feeder, that way it will last longer and when it opens it would have thawed and is still good

 

[OlliesArmyof1]

I'm sorry to say that given her diabetes and the high level of calcium and phosphorus that she has (if only one of them was high things would be a little bit less complicated) I think you need to address both things, high carbs is going to affect his diabetes which as you now can become very complicated and make her feel really bad and high phosphorus can make her have low appetite, loose weight, have nausea, stomach acid and also in combination with the high calcium can damage some organs especially the kidneys

So you do need to find a low phosphorus low carb food that he likes but since the most important thing is that she eats you could also consider giving her the food that she likes (as long as is low carb no way around that) and a phosphorus binder this is a link with a lot of information about phosphorus binders (http://www.felinecrf.org/phosphorus_binders.htm)


I use a timed auto feeder, actually the comercial wet food will last for a few hours out before anything happens, but if is warm weather or I know there are going to be a lot of hours what I do is I freeze a bit of the food in advance and place it on the feeder, that way it will last longer and when it opens it would have thawed and is still good

Question about the phosphorus binders. It looks like they might be available to purchase without a prescription in the US through the right sources? Since he is so picky, I'd be interested in trying them out just to help some in the meantime while I struggle to get him to switch. I'm not sure I could get the vet to write a prescription. Are they relatively safe?

 

[Veronica & Babu-chiri]

Question about the phosphorus binders. It looks like they might be available to purchase without a prescription in the US through the right sources? Since he is so picky, I'd be interested in trying them out just to help some in the meantime while I struggle to get him to switch. I'm not sure I could get the vet to write a prescription. Are they relatively safe?

They are relatively safe, most people use Aluminium Hydroxide or Ipakatine ( this is calcium based so not an option for her ) because I understand you do not need a prescription, is relatively cheap and easy to mix with the food almost all the binders cause some degree of constipation so you need to consider that.

In my case I'm using Renvela because aluminium hydroxide is not available where I live with or without prescription and I didn't wanted a calcium based one either, and it has worked quite ok but is a bit pricey

I've known there are people using Niacinamide (Vitamin B3) and I will probably try that one if I can get the B3 here some time soon but I can't really comment on it