"Triaditis" leading to urinary food aversion...

[StephMo]

Thank heavens to anyone who can read all of this. Bless you.

I'm the owner of an indoor-only, 11 pound (that's the lower end of his healthy weight - he's a big boy) 12 y/o neutered male kitty. His name is Mouse. 8 years ago he was put on Royal Canin Urinary S/O; I have fed a wet/dry mix faithfully ever since an have had no problems with him eating this. He has gotten his bloodwork done and teeth cleaned every 12-18 months his entire life, always comes out with a clean bill of health. Even at 12 he still gets "the zoomies" like a much younger cat. He's never been sick until about 30 days ago... I'm reaching out to this community for "food wisdom" in light of the below complicated timeline of events, and where this could possibly lead... please help me if you have experience with this - this kitty is my entire world.

• Week of 5/30/22: His appetite decreased over the course of 5 days, but I didn't take it seriously fast enough. Thought he was just being a brat, because sometimes he can be bratty so I'll cave in and offer something more delicious - like half a chicken breast. In hindsight I was very wrong.
• Mon 6/6/22: 1st Vet appointment w/ diagnosis of UTI. He was given a 2-wk antibiotic injection and sent home. (Liver value was very high at 450 though, and Bilirubin was elevated at 1.1)
• Week of 6/6/22: Appetite did not bounce back as it should despite being treated for UTI
• Mon 6/13/22: 2nd Vet appointment with diagnosis of mild pancreatitis and prescribed: Cerenia (for nausea), Mirtazapine cream (appetite), Denamarin (liver) . (Liver value had dropped to 214, but Bilirubin had increased to 2.1)
• Wed 6/15/22: Vet added Miralax to his protocol since he's now not pooping out whatever I do manage to get him to eat. Vet also added Buprenorphine (pain killer).
• 6/15/22 - 6/19/22: His appetite improved slightly during this time period but he's favoring foods other than his urinary diet, so vet pulled him off the Buprenorphine pain killer but kept him on the Mirtazapine cream.
• Thurs 6/23/22: 3rd Vet appointment. His appetite tanked after coming off the Buprenorphine despite the fact he was on Mirazapine cream so we discontinued Mirtaz. By this appointment his weight is down to 10.4 pounds from 11 pounds a month ago. Vet also added Omeprazole (antacid) because she said a lot of pancreatitis kitties can benefit from this.
• Fri 6/24/22: Vet prescribed Cerenia to deal with his very obvious Mirtaz withdrawal symptoms (in humans, Mirtazapine is an anti-depressant and can cause extreme nausea when discontinuing suddenly)
• 6/25/22 - 6/26/22: his appetite is just not getting great. He'll eat small amounts of canned or fresh chicken and albacore, but he will not touch any type of urinary Rx food.
• Mon 6/27/22: Vet told me that at this point, she suspects his pancreatitis has progressed to full-blown "Triaditis" and only has a couple options left to get him fixed up unless I want to consider 24/7 hospitalization (I cannot afford that). So what this means is, if this last-ditch effort doesn't work, I'll have to schedule the last day of his life on a calendar. The last option left is putting him on Prednisolone (steroid) and re-starting the Buprenorphine (pain killer). Upon giving him the pain killer his appetite resumed and he ate chicken really well, and his behavior improved significantly --- which tells me he was in a lot of pain during the time period he was off of the Buprenorphine.
• Wed 6/29/22: 4th vet appointment. Blood work is better (Liver value dropped to 191 which is still way too high, and Bilirubin was back down to 1.1). His ultrasound showed a small intestine issue that I'm waiting to hear full results on at the moment. He had really good appetite last couple days after coming home from the vet. I think he ate over half of a plain-cooked chicken breast in one sitting.
• Thurs 6/30/22: back to zero appetite again, lethargic... sigh...

All that to say (thank you if you actually read it I know it's lengthy), my overall concern here is: I have a cat, who I love more than myself, who is slowly recovering (very slowly) from Triaditis. He has become a PICKY eater during the past month, and is no longer eating his urinary Rx food AT ALL. So, for now, vet says just to feed him whatever he will eat just to save his life, which I understand --- BUT, if he recovers from Triaditis I will come out on the other side with a cat who develops an entirely different problem related to not eating the urinary food, and THAT could end his life. I've already spent $2,250 on the above timeline, with an anticipated $500-1,000 more to pull him through this. ....only to lose him down the line over urinary crystals? Does anyone on this blog understand my 'down the road' worry here? What on earth do I do?

 

[Furballsmom]

Hi!

Does anyone on this blog understand my 'down the road' worry here?

Too many of us do understand, I'm afraid .

I'm going to post a couple of links for you, and your vet is right, he must eat. Consider hand feeding for a meal or two daily, since that way you can get his wet rx food into him. There are YouTube videos for syringe feeding wich I personally think is a hassle, but my vet showed me a method that also works. I lift him on a counter with a nonslip drawer liner for him to step on so he doesn't slide. I use pate style food (with a little water added and mixed in), scoop a bit on the end of a tongue depressor/popsicle stick, open his mouth and slide the food off onto his tongue.

However, you're a long way (I hope) from kidney issues... You didn't say what his kidney numbers are, but those will tell you a fair bit.

Since 2019 my boy has had liver, pancreas, kidney and now thyroid numbers that are elevated, and I'm walking a balance beam taking care of as much as I can without upsetting something else. My point is that he's still loving life, having zoomies, jumping on the fridge etc, and you may find the same happens for your cat.

Here are more ideas;
Any Good Tips To Get Your Cats To Eat? Share Them Here!

and I don't know but maybe there's something here;
No Money For Vet Care? How To Find Help And Save Your Cat’s Life – TheCatSite Articles

 

[Alldara]

What kind of crystals did he develop originally?

The positive news is: feeding a fully wet food diet has just as much of a positive impact on cats with FLUTD and other chronic urinary issues as a urinary diet for MOST cats. Oral glucosamine and the management of feline idiopathic cystitis - PubMed

You can provide some fish oil to reduce inflammation, if your vet agrees that it doesn't react with medicine.

In line with the above study, you can provide glucosamine if your vet agrees that it won't interact with medicine. It can help to lower inflammation. The studies show that wet food is the best prevention of urinary issues, but they've also found cats with urinary issues tend to have low glucosamine values which is what led to the studies. It could, perhaps be the reason they are more likely to develop it, but have little to do with preventing reoccurrence after development. However, good to lower inflammation like I mentioned.

There's many non-prescription urinary foods you could try that he might eat.

If you know the original stone type, you can find a few that is lower in that value. Ex. Nobel's were calcium stones, so simply changing to a food free from cheese was fine. Previously was feeding Fromm and one of the regular flavours I would get had cheese.

I don't have experience with triadic cats, but found this throughly written article which may help: Feline Triaditis – IBDKitties

Hope some of this is helpful and/or comforting.

 

[StephMo]

"However, you're a long way (I hope) from kidney issues... You didn't say what his kidney numbers are, but those will tell you a fair bit."

[/QUOTE]

Thank you for responding.. He's had three rounds of bloodwork and while I know kidneys are a part of that, they were not mentioned to me as an issue, but I will certainly ask when I talk to my vet tomorrow. I like the idea of 'force feeding' a watery soup of the urinary food with a little syringe, but -- I imagine that he would develop an even worse aversion to it in the long-term due to associating the smell with being force-fed? And I'd still have to supplement with the chicken breasts. He's supposed to be 11-11.5 pounds. Yesterday he was down to 10.1 which I failed to mention in my novel. I'm interested in switching him to one of those raw-food diets, which is why I posted this in the other forum category... seeking people who have had success with urinary kitties on a chicken breast diet long term.

 

[Furballsmom]

I imagine that he would develop an even worse aversion to it in the long-term due to associating the smell with being force-fed?

It doesn't matter, and actually probably not. Keep in mind, you may need to be on the handfeeding train for the rest of his days as I am here, since Poppycat isn't a fan of pate but must get his milk thistle and now Hills y/d daily. Or, you find that things improve and you don't have to continue after a while.

 

[StephMo]

"What kind of crystals did he develop originally?"

[/QUOTE]

Oh boy - that was so far back in the way-back machine, and an out-of-state move ago. I know there's two types of crystals but I don't know which kind. Thank you for the link.. I'm going to do more homework and see if I can get my vet to "think outside the Rx food box" to maybe even help me with a homemade recipe that will work long-term just based on nutritional information and 'common sense'. The sad part about his food aversion: I'm a bit of a prepper and have already stocked up on probably $600+ worth of RC S/O wet and dry to carry him through whatever 'supply chain chaos' may lie ahead. So my ultimate dream is just to get him back on that food.

 

[Furballsmom]

The raw food option is something that could be an answer since there are add-ins (such as EZComplete) with all the vitamins and minerals ready to go, some of these allow for the food to be heated and one or two work with cooked meat. You could start a different thread in the raw and home cooked forum simply titled triaditus cat what diet is best, with a brief summary of his current situation. But, maybe first talk with your vet, since you need some more answers first.

I'm a bit of a prepper and have already stocked up on probably $600+ worth of RC S/O wet and dry to carry him through whatever 'supply chain chaos' may lie ahead. So my ultimate dream is just to get him back on that food.

Yeah, me too
In any case, one step at a time. Get food into him now, get him gaining weight instead of losing it, and see where you are then.

 

[Furballsmom]

Oh, speaking of vitamins, minerals and such, if you can't get some of his commercially made food into him by whatever process (there are some terrific tips to try regarding getting him eating again in that first link I posted for you besides the tongue depressor method), you may want to consider purchasing taurine at the least to add to that chicken.

 

[StephMo]

Oh, speaking of vitamins, minerals and such, if you can't get some of his commercially made food into him by whatever process (there are some terrific tips to try regarding getting him eating again in that first link I posted for you besides the tongue depressor method), you may want to consider purchasing taurine at the least to add to that chicken.

I am checking out that "how to eat" thread and I'm already doing a lot of things there... fortiflora was working - until it wasn't. Looking back on the past month, his aversions started when he was in pain. He was eating his urinary food (just not enough) until the opioid was stopped, so I think he may associate that particular food with pain now. I haven't tried crushing the dry food. Will do that soon. The parmesan was interesting. I've also tried being 'sneaky' about mixing in the Rx food with the chicken, but he's way too smart for that. I've made a note to ask my vet about Taurine, thank you. My heart needs 20 years of mileage out of him, so the thought of losing him so premature is really heartbreaking.

 

[Furballsmom]

Poppy and I made it through that, and you likely will to. I think it might be challenging to know whether he became reluctant to eat because of nausea. Some cats just have trouble getting back to eating as they should after that.

By the way, take a look at the ingredients and nutrient analysis and see if you can find a food that's similar. If you can find something that he is willing to eat you could mix it with the rx food and you'd be back in business.

One more thing to double-check on with your vet is whether your baby is dehydrated, and if he needs fluids. Which liver number are you referring to?

I guess my other point is, can you get a second opinion?

 

[LTS3]

The unopened SO can be returned to the vet or wherever you bought it for a refund.

SO may not even be necessary for urinary issues. See these TCS threads:

Alternatives to expensive Urinary SO food

Hi folks, I have had my kitties (all boys) on Urinary SO food as two of them have had crystals. However, at 100$ a bag it's not practical for me to feed three cats this food. I am continuing to feed it - but in all honesty 100$ is a steep price for a bag of cat food that doesn't even have that...

thecatsite.com

Urinary So Substitute?

Found out Alli has struvite crystals. The bag of urinary so is $75 on chewy. Oddly the cans are more on chewy then the vets office :/ What does that RC have that shrinks the crystals?

thecatsite.com

Alternatives to Royal Canin SO

My 6 month old kitten was having some problems and my vet recommended RC SO she gave me a gallon bag to sample to see if my Ripley would eat it. I started mixing it in to his current dry food which is Iams so either way I have to find him a new food since that was the food he was on when we...

thecatsite.com

It's ok to disagree with the vet about food Most vets don't support raw or home cooked diets but that's no reason for you to go ahead and feed those as long as you follow a reputable recipe.

There's info here on triaditis:

Feline Triaditis – IBDKitties

www.ibdkitties.net

Feline Triaditis: Inflammatory Diseases of the Liver, Pancreas and Small Intestine - WSAVA2011 - VIN

www.vin.com

 

[StephMo]

Poppy and I made it through that, and you likely will to. I think it might be challenging to know whether he became reluctant to eat because of nausea. Some cats just have trouble getting back to eating as they should after that.

By the way, take a look at the ingredients and nutrient analysis and see if you can find a food that's similar. If you can find something that he is willing to eat you could mix it with the rx food and you'd be back in business.

One more thing to double-check on with your vet is whether your baby is dehydrated, and if he needs fluids. Which liver number are you referring to?

I guess my other point is, can you get a second opinion?

The liver number is whatever one indicates inflammation or possible fatty liver disease. It's coming down, just real slow. I guess the UTI caused the lack of appetite, which inflamed his liver, which screwed up his pancreas, which has now spread to his small intestine. He's gotten subcutaneous fluids every time he's been to the vet and pees plenty so I'm not worried about dehydration at the moment.. whatever chicken he does eat, I squirt water on it continuously. Tonight I tried syringe feeding a soupy mix of the urinary food and he was not happy about that! I'm going to get a bigger syringe from my vet tomorrow in case this becomes a normal thing. I also boiled him some chicken breast and thighs - his appetite is so-so, but he's trying.
And yes, I've gotten a second opinion. There were two vets involved, and now a third -- whoever is currently reviewing his ultrasound.

 

[StephMo]

The unopened SO can be returned to the vet or wherever you bought it for a refund.

SO may not even be necessary for urinary issues. See these TCS threads:

http://[URL]https://thecatsite.com/threads/alternatives-to-expensive-urinary-so-food.254489/

[/URL]

http://[URL]https://thecatsite.com/threads/urinary-so-substitute.390347/

[/URL]

http://[URL]https://thecatsite.com/threads/alternatives-to-royal-canin-so.328238/

[/URL]

It's ok to disagree with the vet about food Most vets don't support raw or home cooked diets but that's no reason for you to go ahead and feed those as long as you follow a reputable recipe.

There's info here on triaditis:

http://[URL]https://www.ibdkitties.net/feline-triaditis/

[/URL]

http://[URL]https://www.vin.com/apputil/content/defaultadv1.aspx?id=5124292&pid=11343

[/URL]

Thank you for the links. I'm very interested in going a more natural route - although... two packs of organic chicken at costco today cost sixty dollars!! Wowzers.. makes my stockpile of royal canin seem cheap by comparison. So I've got a lot of motivation to keep him on the food I already have just because I'm guessing a chicken is going to cost $100 soon. I've got notes for my vet about the taurine and EZ supplement if he has to stay on chicken longer. My main vet is very open minded so hopefully she has some tips as well. I've also read that chicken can aggrevate GI issues, which might explain why his appetite is so up and down. He'll eat really well for one meal, then not eat much for the next three meals.. so on and so forth. If chicken is irritating him that might be why.

 

[LTS3]

Yes, chicken is known to be a culprit of tummy issues in many cats. If you can try a novel protein like rabbit that would be better.

You can look in buying raw meat from a raw pet food supplier such as Hare-Today.com. Lots of novel protein choices there. I'm not sure if that would be any less expensive than the supermarket or a butcher shop since there is a shipping cost and a cost for ice packs so the meat stays frozen in transit.

 

[Furballsmom]

The liver number is whatever one indicates inflammation or possible fatty liver disease

I meant what is the abbreviation on the lab report?

These vets are all within the same clinic?

 

[StephMo]

I meant what is the abbreviation on the lab report?

These vets are all within the same clinic?

I’ll ask the abbreviation tomorrow… I don’t have a copy of the actual bloodwork report. All I know is it’s a number that should be below 100. The vets are two separate clinics. The initial UTI diagnosis was done at the fanciest vet in my town (they have a research center and what not, clinical trials, that sort of thing) and then I transferred his care to my day to day vet because I trust her instincts more even though her clinic isn’t one that does really elaborate surgeries. His ultrasound got sent off to some third party specialist…
This inflammation issue is a big deal in cats, I’m learning that the hard way - my heart breaks for others I’ve seen post about this. It’s a rollercoaster of emotions watching the kitty go through it. Seems to hit them like a freight train.

 

[StephMo]

Update on Mighty Mouse per your lovely and helpful comments and suggestions:

1. I'm going to add taurine to his diet by buying sardines/shrimp/scallops on my way home today. Those seemed to be the top food sources to get it naturally. He loves these things, so if he's sick enough to not want to eat any of these then I sadly have bigger problems than taurine. I can find NO pet store in my town who stocks a feline taurine supplement and if i order online I'm waiting until next Tuesday to get it at the earliest... can't wait that long
2. No store in my town sells EZ Complete (WTF!), same story with online shipping. However, there is an alternate product I can buy called Nupro and I'm going to ask my vet if it's safe for a "triaditis" kitty. I can crush the pieces into a powder and turn it into a gravy he might enjoy.
3. His small intestine ultrasound results are still ball-in-court the ultrasound specialist but his case was elevated to a "stat" status so hopefully they look at it before the long weekend.
4. I asked the vet for a larger syringe to take home so I can administer a soupy RC S/O blend straight down his gullet. He's NOT cooperative enough for the Popsicle stick technique unfortunately. LOL.

Thank you all, really. These questions I wouldn't have even known to ask about or research.

 

[Furballsmom]

He's NOT cooperative enough for the Popsicle stick technique unfortunately.

Bless your heart for trying, it can a three handed job depending on the cat

 

[StephMo]

Bless your heart for trying, it can a three handed job depending on the cat

Well, there's only two human hands in my household, and I don't have feet that can 'do things' - LOL!!

So my employer graciously let me leave half a day early (for the 4th week in a row now...) to go run 'cat errands'. Photos attached of what I bought, all of this got run by my vet too. AND - these ideas are from this website - so THANK YOU!

Turns out taurine isn't one of those supplements that most pet stores in 'moderately sized' cities keep in stock, so I stopped by the snottiest grocery store we have in my area and bought the best scallops and shrimp they had. He's allowed either one scallop or one shrimp per day to get some taurine. Mouse is officially eating better than I am at this point.

I also bought the Nupro (similar to EZ Complete) to put on his boiled chicken if he continues to be a brat about canned food. Vet gave me a couple huge syringes to get the urinary food in him if all else fails over this long weekend.

My local pet supply store recommended I try a food I'd never heard of, so I posted photos of the cans. It's from Canada - limited ingredient, similar to a "home prepared" meal - and MAY be a suitable option to replace the RC S/O diet if he's just decided, "you know what - I'm old - been on this crap tasting RC food for 8 years and I want something tasty for the rest of my days". The one good thing about living outside a big city is that little businesses like this will place special orders for individuals, and they told me if I need to replace my "doomsday stockpile" of the RC S/O with this new food, they'll get me a good deal on a 1+ year supply. I'm going to talk to my vet next week about transitioning him off this Rx food by incorporating the advice I've been given from this website and challenging her to think outside the box of "Rx food is the only option". I no longer believe that - there's too many people on this site who have overcome urinary crystals without Rx food. I've fed him a couple ounces and HE'S ACTUALLY EATING IT.

His ultrasound results came back and turns out all that's wrong at this point is just a mild case of pancreatitis, praise God - we just don't know why it's taking him so long to recover. If I had to guess - it's because for 12 years of his indoor-only life he's literally never been sick, so it's just hitting him hard.

I'll post updates, but seriously thank you for the attentive and thoughtful responses. The links are wonderful - I have used them. You ladies are wonderful.

 

[Furballsmom]

Wow, gracious sakes, this is a terrific update!! I'm seriously doing a big happy dance on your behalf