Best food for senior cat with CKD & possible IBD

Sienna221

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I have a 17 year old beloved cat. Several years ago he was diagnosed with early CKD...but his numbers were only slightly elevated and have only slightly worsened over the years. Around September ‘20 I notice he started losing weight. Since then he has been in and out of the vet (which he hates). He has gone from 8.5 lbs his whole life to now just over 4 lbs. He also constantly throws up and hasn’t had solid stool in 9 months. Here is a overview of what we have tried:

- Added in a wet food (alternate between Blue Buffalo Natural Veterinary Diet K+M Support Grain Free and Hill’s Prescription Diet k/d Kidney Care - he is a grazer and picky so really just whichever he’ll eat. I now see that Hill’s most recent order is Vegetable & Tuna Stew)
- Still eats dry food (currently mixture of mostly Blue Buffalo Natural Veterinary Diet K+M Support Grain-Free Dry Cat Food with a little Hill’s Prescription Diet w/d Multi-Benefit Digestive, Weight, Glucose, Urinary Management with Chicken Dry Cat Food)
- Tried Royal Canin Cat Multifunction Renal Support + Hydrolyzed Protein Dry Food...no change
- Gets 50mL of Lactated Ringers (Sub-q fluids) 2x per week to help with dehydration...but they don’t want him getting more because o
- Tried 2 rounds of Metronidazole with no luck
- Completed 1 round of Prednisolone (Steroids) with no luck when the vet started thinking IBD
- Had Thyroid tested...everything looked fine
- Had more bloodwork and urine analysis done recently and kidney values were still only slightly elevated so the vet doesn’t think worsening CKD is reason for weight loss/vomiting/soft stool

The vet now wants to do an abdominal ultrasound to check for thickening in the intestines or cancer. Then put him on a more aggressive round of steroids...but would have to monitor him due to the CKD. So I am really at a loss of what to do. He hates going into the vet so much so I’d hate to keep making him go if it’s just needing to accept that he is 17 y/o. So my thought is to make sure I have him in the right diet.

So novel condensed to my actual question...with all these health (but mostly CKD and IBD) and a picky cat, what would be the best diet to have him on?

And I see lots of recommendations for raw. I don’t know anything about it and honestly worry he wouldn’t like it.
 

daftcat75

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The relentless weight loss and the chronic loose stools sounds more like GI lymphoma than IBD. Is he able to maintain or even gain weight when he eats a normal or more than normal amount? Or does he lose weight despite eating more than normal? If the latter, that sounds like lymphoma. The good news is that cats tolerate chemotherapy very well. Cats experience mild side effects if they have any at all. Krista slept a little more on dosing days. And if you can get a remission, many cats have a year or more before it comes back. The bad news is that you still have to sort out his triggers and avoid them if you want him to achieve a meaningful remission.

I’ve read mixed messages about putting an immune-compromised cat on a raw diet. The steroids he is taking and the chemo he may end up taking puts him in that immune-compromised category. However, you may find homemade cooked food a helpful alternative.

You’re not going to get anywhere with IBD or lymphoma with dry food in his diet. Dry food has too many irritating and inflammatory ingredients. Too many biologically inappropriate ingredients.

My recommendations:

1. I recommend Rawz wet food pates for his food. They are the gold standard for IBD kitties for conducting food trials and finding a trigger-free food. They have several single protein pate foods that don’t have gums or any other biologically inappropriate ingredients (starches, grains, fruits, and veggies.)
2. Eliminate the dry food if you can. If you can’t. see if you can find something as close to mostly meat, single protein if you can find it, and a different protein than he has been eating. Novel proteins only have to be novel to this cat. Not all cats. Often switching from chicken to turkey is enough. If you can avoid all chicken ingredients. And that’s the rub. There’s just too many dang ingredients in dry.
3. Get the ultrasound. It’s not going to tell the difference between IBD and small cell GI lymphoma. For that, you need a biopsy. I don’t recommend this for your cat since he’s older and has already lost so much weight. A surgical biopsy may result in more weight loss he may not be able to recover.
4. If he’s been eating an adequate or more than adequate amount of food and taking steroids and still losing weight, that tells me one of two things. The triggers in his diet are more powerful than the medicine he’s taking. Or. It’s not IBD but lymphoma that you’re dealing with. Figuring out food triggers is on you. And convincing the vet that more pred may not be the answer but rather giving chemo a try, that will also be on you. Many vets don’t want to try chemo without confirming cancer. But in your guy’s case, the drug is less risk than the diagnosis (the biopsy.) That’s what you’ll have to convince your vet of. You may have to strike a bargain that you’ll try a course of the more aggressive steroids first. Get the vet to set a time limit on this trial. If it doesn’t produce meaningful results in that time, then add chemotherapy. But personally, my non-professional opinion says aggressive steroid therapy may be too much for a 4 lbs cat. Steroids are hard on a healthy cat. I do believe chemo is probably your least risk option right now even if you don’t have a cancer diagnosis. Discuss this with your vet. Lay out the options, risks, and prognosis.

I’ll just stop there before I get too far ahead here on the recommendations.

TLDR: Find his food triggers. Consider chemotherapy even if you don’t confirm with a biopsy.
 
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Sienna221

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daftcat75 daftcat75 Thank you so much. That is all really so helpful. I've been feeling just at a loss and not like my vet is providing real helpful information anymore and just doing this to check things off the list to appease me but really just chalking it all up to "he's 17 y/o and going to have issues now that you can't fix".

And yes, you are correct with his weight. He has always maintained a normal, healthy appetite through this whole thing. So eating completely normal but continuing to lose weight. He has always urinated a lot...obviously so with renal issues and getting fluids...but it has become very bad recently and not always using his litter pan.

I am going to order some of the Rawz wet food now and do some research for a better dry food option. With how picky he is...I'm not sure completely eliminating dry food right now is an option.

Do you have any knowledge of subscription "home cooked" meal services...like NomNomNow? I had read some benefits of that and was thinking about trying.
 

daftcat75

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I'm going to be really adamant about this. You're not likely to get anywhere with food trials with dry food in his diet.

Krista's vets were the pred-and-pray type. When she failed to respond to pred, their answer was more pred. I begged her vet to try chemo. She said she wasn't comfortable prescribing chemo without a cancer diagnosis. I went over her head to the owner of the practice and said something like the following:

We have 4 options here:
a. Do nothing. Obviously this is not a viable option.
b. Surgical biopsy on a cat who can't regain any weight she will lose recovering from the procedure.
c. More pred. Pred is hard on healthy cats. But I'm not sure more pred is good for this cat in her already weakened condition.
d. We try the leukeran (chemo) even without an official diagnosis

When we look at these options, the drug is less risk than the diagnosis (the biopsy.) And if it doesn't work, there's always more pred.
Fortunately the owner of the practice agreed with me and wrote a prescription for the chemo. Krista's liquid poops firmed up after one dose.

But not completely. She would continue to struggle for months with what I called, "poop nonsense." It presented like diarrhea. But I'm pretty sure it was in fact inflammation. She would always put a fantastic and firm first poop in the litter box. Then all bets were off. She often had one or two more rounds of poop that were softer than the first. Sometimes she put one or both of these in a box. Sometimes she had enough and put it on the carpet. And nearly every time, if she went out to three rounds, she was throwing up afterwards. We struggled with this for months. (Bissell makes fantastic mess cleaners.)

And then she had an ear infection requiring surgery that forced my hand into changing the way I was giving her nightly pred. For months, I would get her to pill herself by cutting the pill in half, moistening it with food, rolling it in s. boulardii (a yeast-based probiotic), and wrapping that yeasty pred in a bonito tuna flake. Since she was already toothless from her battle with FORLs, she found it easier to nom-nom-swallow the yeasty-fishy-pred bites than trying to pick them apart. I knew full well that the fish flakes were a trigger. But I called it our "devil's bargain". Besides, I couldn't get an answer one way or the other from the vet (🤷‍♂️🤷‍♂️) about whether that little amount of trigger was going to set us back considering the chemo and pred she was taking. But after her ear surgery, I switched her to transdermal pred. She finally reached remission practically overnight. The poop nonsense finally ended!

Unfortunately, for her (for both of us), it was too little too late. She had been on pred (and more pred because we upped her dose when the chemo failed to end the poop nonsense completely) for so long that her weakened little 4 lbs body (formerly 9 lbs) could not fight off a bladder infection.😿🌈 I take a small amount of comfort in knowing that her last month was spent in remission. But I also feel a huge amount of guilt and regret knowing that I could have brought her to remission a lot sooner had I avoided the "devil's bargain" and got her on transdermal much sooner. I should have gone with my instinct that feeding her a nightly trigger to get her to take her medicine was not helping. Chemo probably gave us another six months. If I had done transdermal from the start, who knows how much more time she would have had with a remission? She might still be parking herself on the desk between me and the keyboard.

So I say to you, if you want your guy to reach remission (and this applies the same whether he has IBD or lymphoma), you will need to find his triggers and remove them. Otherwise, you may be left with an incomplete remission like Krista. The sooner you reach remission, the sooner you can get him off pred which is not good for him in the long-term. You may need to keep him on a maintenance dose of chemo. But that's going to have fewer side effects and fewer long-term risks.
 
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daftcat75

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I am not familiar with subscription homecooked services. I'm sure they are out there. But they are likely predominantly chicken-based. I would start your food trials by crossing chicken and fish off his list including chicken liver, "poultry meal", and "poultry by-products." That's going to cross off most dry food. Even the boutique "high quality" dry foods have questionable ingredients like flaxseed, tomato pomace, cranberries, and pea starch. None of these are part of a cat's evolutionary diet. You just don't know if any of those might be causing an issue until you eliminate them.

I recommend ordering samples of EZ Complete (which does have chicken liver but for a sample, it's worth a shot) and Alnutrin. Both are supplement premix powders you can add to cooked meat to make a balanced and complete cat food. EZ Complete is easier because it already has freeze-dried liver added to it. But it's chicken liver. So that may not work for him. With Alnutrin, and many of the other powders, you have to add your own liver. This gives you flexibility, though. You can use freeze-dried liver in place of fresh liver with a small calculation to adjust for the difference in weight between fresh and freeze-dried:

(100-% moisture fresh)/(100-% moisture freeze-dried) * desired amount of fresh

Find the % moisture fresh from USDA food database for the particular liver you are using. Find the % moisture freeze-dried from the label of the freeze-dried. The desired amount of fresh will come from the supplement premix instructions.

Homecooked can be a whole other issue trying to get your operation going and getting a cat to take to it. I recommend starting a new thread in the Raw and Homecooked subforum under Cat Nutrition forums when you're ready to start with that.

Rawz will send you samples if you write them. I recommend asking about the turkey recipe, the rabbit recipe, and the rabbit and pumpkin recipe. If you go the rabbit route, it's helpful if he'll eat both the rabbit and the rabbit with pumpkin because the latter is usually easier to find than the former. But both are subject to shortages. When you find one he thrives on, stock up every chance you get.
 
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LTS3

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Some TCS threads on subscription home cooked foods:


It may be cheaper to make a home cooked diet yourself. It's easy to do with a pre-mix such as EZComplete. The Raw and Home Cooked forum here on TCS has more info.

A raw diet is great but many cats won't touch it. Home cooked is usually more acceptable. I feed my IBD cat a commercially available raw diet.

There's a list of stores and authorized web sites to buy the Rawz canned food from: Where to Buy | RAWZ Amazon is not an authorized web site even though you can find Rawz there.
 

Astragal14

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Have you been giving him a probiotic at any point? As long as his white blood cell counts are okay, you should definitely give a probiotic with/at least after antibiotics.

One of my cats has IBD and two things that have helped immensely are Rawz wet food and Visbiome probiotic. But some notes about the Rawz:

1. My cat didn't like it at first so I transitioned with his favorite wet, he now eats all the turkey flavors by themselves (he loved the duck and rabbit, but see note #3). The other flavors are still mixed with about 1/3 other wet food.... we're slowly getting there!
2. Check the ingredients of the Rawz flavors, I know the Beef pate has tricalcium phosphate as its 4th ingredient.
3. The consistency of Rawz has been very inconsistent lately. I know lots of brands have been having canning issues the last year, I've even seen some brands proactively say to not be alarmed when the food looks different because they used a different cannery with the same ingredients. Rawz appears to be having the same issues, the salmon, duck and rabbit flavors look completely different than before. And of course my IBD kitty hates the new versions! So please don't give up if your cat doesn't like the Rawz just yet!
 
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