IBD or not feeding enough? Is ultrasound really needed?

[Susanna72]

Hi. My cat Timothy has lost a pound since April. He's on thyroid medication so I thought maybe it was that and his meds need adjustment. His bloodwork is normal except for onset of kidney disease. (He said something about renal failure within two years. He's 15.) He is suggesting an abdominal ultrasound to rule out IBD. But when I called the specialist who does it, they asked about symptoms. Basically weight loss. He's 14 lb. 11 oz. No vomiting. Not lethargic. No diarrhea. No other IBD symptoms. I looked it up and I don't think I'm feeding him enough. I'm giving him three cans of Fancy Feast Gravy Lovers a day (I decided to start spoiling him last Spring). Now I'm thinking I should switch to Hills KD or the Royal Canin Renal. I canceled the abdominal ultrasound for now. I'm going to try the kidney food and try to fatten him up. If he's still losing over the next six months, I'll do the ultrasound.

What do you all think? Is weight loss enough to warrant an ultrasound? Could it still be IBS? What do you think of my plan?

 

[FeebysOwner]

Hi. Personally speaking, I am with you on your plan. Given the lack of symptoms, I would wait to have an ultrasound done. I take it from what you said, his T4 is in a good range?

Ultrasounds do not usually determine IBD/IBS on an absolute basis - the biggest indicator would be to see thickened walls of the intestines, which is still not a definitive diagnosis. Fine needle aspirations (non-invasive) can be done during an ultrasound if something suspicious is seen and can be a better determinant to diagnosing IBD but is still no guarantee.

What were his kidney levels (mainly creatinine, BUN, and phosphorus)? I would not put him on the renal foods just yet, or maybe never. All most of the prescription ones do is lower the protein level and the phosphorus level in his food. Lowering protein in an older cat, even with kidney disease, is considered counter-productive because all it does is lend to muscle mass loss, which cats experience as they age anyway. And lowering phosphorus, unless the blood work shows it is pretty high, is not always the best thing to do in the very early stages of CKD (chronic kidney disease). There are non-prescription foods available with lower phosphorus counts that don't compromise the protein level as much. Below is a link to a list of them from Tanya's web site, which I highly recommend you start reading the entire web site over time to familiarize yourself with 'all things having to do with kidney disease'. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease- Canned Food Data USA (felinecrf.org)

Have you considered having a cobalamin (B-12) blood test done? It would tell you whether or not malabsorption could be contributing to the weight loss issue. This is an easy fix, so to speak, as B-12 shots can be given sub-cutaneously at home by you. It is a lot easier to do that you might think. It doesn't resolve why there is a malabsorption issue but can at least help remedy it, and possibly aid in reducing weight loss. B-12 might be given more frequently at the onset but is usually slowed down to once a month.

I could go on and on about all of this but will stop here as I have overloaded you with enough information at this point.

 

[mrsgreenjeens]

I agree with waiting and seeing if you can fatten him up a bit first. I also agree with the above in that you might not need to put him on Renal food just yet, depending on what stage he's in with his kidney issues. Even if you were to simply switch from the gravy lovers to the FF pate you would increase his calories quite a bit. BUT again, it depends on what stage he's in, because the FF pate is higher in phosphorus. But there are plenty of choices out there you can chose from. Just look at the calories on the can.

 

[Susanna72]

Hi. Personally speaking, I am with you on your plan. Given the lack of symptoms, I would wait to have an ultrasound done. I take it from what you said, his T4 is in a good range?

Ultrasounds do not usually determine IBD/IBS on an absolute basis - the biggest indicator would be to see thickened walls of the intestines, which is still not a definitive diagnosis. Fine needle aspirations (non-invasive) can be done during an ultrasound if something suspicious is seen and can be a better determinant to diagnosing IBD but is still no guarantee.

What were his kidney levels (mainly creatinine, BUN, and phosphorus)? I would not put him on the renal foods just yet, or maybe never. All most of the prescription ones do is lower the protein level and the phosphorus level in his food. Lowering protein in an older cat, even with kidney disease, is considered counter-productive because all it does is lend to muscle mass loss, which cats experience as they age anyway. And lowering phosphorus, unless the blood work shows it is pretty high, is not always the best thing to do in the very early stages of CKD (chronic kidney disease). There are non-prescription foods available with lower phosphorus counts that don't compromise the protein level as much. Below is a link to a list of them from Tanya's web site, which I highly recommend you start reading the entire web site over time to familiarize yourself with 'all things having to do with kidney disease'. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease- Canned Food Data USA (felinecrf.org)

Have you considered having a cobalamin (B-12) blood test done? It would tell you whether or not malabsorption could be contributing to the weight loss issue. This is an easy fix, so to speak, as B-12 shots can be given sub-cutaneously at home by you. It is a lot easier to do that you might think. It doesn't resolve why there is a malabsorption issue but can at least help remedy it, and possibly aid in reducing weight loss. B-12 might be given more frequently at the onset but is usually slowed down to once a month.

I could go on and on about all of this but will stop here as I have overloaded you with enough information at this point.

His T4 was fine. Everything was fine, really. Just that one number that sort of "predicts" that he could have renal failure in the next two years. I guess he's high risk. I got the KD, but I'm going to return it based on what you said. The first cats I ever had ate KD for the last few years of their lives and they definitely had muscle deterioration towards the end.

 

[Susanna72]

I agree with waiting and seeing if you can fatten him up a bit first. I also agree with the above in that you might not need to put him on Renal food just yet, depending on what stage he's in with his kidney issues. Even if you were to simply switch from the gravy lovers to the FF pate you would increase his calories quite a bit. BUT again, it depends on what stage he's in, because the FF pate is higher in phosphorus. But there are plenty of choices out there you can chose from. Just look at the calories on the can.

It's not really a stage. It's a number that predicts renal failure. It's not definite. I wish I could remember the name of it.

 

[FeebysOwner]

It is likely the SDMA test, which is used to predict kidney disease based on blood work and urine testing results. It does seem to be fairly reliable in determining future risk for many cats. Funny thing is my cat, who is in Stage 3 CKD has never had a high SDMA risk rating!!

Muscle wasting will occur no matter what you do as a cat ages, and I think that CKD probably exacerbates that.

At this point, you probably ought to start getting copies of your cat's blood work and urinalysis so you can keep track of any changes over time. I found it helpful to learn about what was being tested and to monitor the changes myself.

 

[silent meowlook]

The abdominal ultrasound is a good idea as it will also tell you what is going on with the kidneys as well as other internal organs. As for the weight loss, as long as his thyroid is regulated he shouldn’t have lost weight.

 

[white shadow]

Personally, I disagree that "skinny" is necessarily inevitable in old age..........

'Haven't read this in ages, might be worth checking out though (Mark Peterson is the fellow who discovered Fe Hyper-T)

Don't Let Your Senior Cat Become a Skinny Old Kitty
Mark E. Peterson, DVM, Dip. ACVIM​

Read this one years ago, a little technical.....so likely material for collaborative work with one's vet.....but, the last paragraph is 'plain-language.':

Skinny old cats: Why some senior cats lose weight. What’s going on?
David A. Williams, MA, VetMB, PhD, DACVIM, DECVIM
School of Veterinary Medicine University of Illinois at Urbana-Champaign​

"With regard to older cats in general, there is some evidence that diet can play a role​

in maintaining body weight and fat mass—and prolonging life. A control diet (nutritionally​

complete and balanced adult cat food) supplemented with antioxidants (vitamin E and β-​

carotene), a blend of n-3 and n-6 fatty acids, and a prebiotic (dried chicory root) was​

associated with reduced decline in body weight and increased longevity (by more than 1​

year) compared with feeding either the control diet alone or the control diet supplemented​

with antioxidants alone.6 These striking observations illustrate the potential benefit to be​

gained from dietary and other interventions to address the gastrointestinal changes that​

appear to be so common in aging cats."​