(Long post) Triad Syndrome and Diabetes - What to do? Feed?

Hello FDMB. I joined the forum a year or two ago when my eldest, Shiro was diagnosed with diabetes. Thanks to the amazing information garnered on this forum we were able to avoid insulin altogether (had lantus prescribed, filled out and in the fridge when his values kept staying too low to warrant insulin!) and he was controlled on a primarily low-carb, wet food canned diet. Unfortunately, something new has reared its head and i'm looking for help/suggestions both in regards to treatment and diet.

First, a little history:

Shiro is 13, and was a feral for the first 4/5 years of his life. He was unneutered with one recessed testicle for most of his life. He is prone to depression upon the slightest pain and had a ludicrous addiction to dry food. He has an enlarged heart and a heart murmur rated a 2 out of 6. Prior to being diagnosed with diabetes he had a case of stomatitis, for which we removed his molars and premolars. Follow up with a round of atopica got that under control as well and it's been around two years since he had to take that. About a two years ago he began to urinate excessively and was lethargic. He was quickly diagnosed with diabetes. As I said, the information from this forum meant that I did my best to put him on a primarily low-carb, wet-food only diet. The problem? My parents continued to give him dry kibble behind my back and would not stop. Please understand that they are not people for whom explaining the medical facts make them alter their behavior; they are illogical and very volatile people - one of whom suffers from Borderline Personality Disorder and the other from Narcissistic Personality Disorder (a joy to be raised by, I tell you.) It's their opinion that it would be better for Shiro to die eating the dry kibble he loves than live a long and healthy life off the junk. I'm currently 100% dependent on them for food, shelter and money. It got to a point where I even tried to look for someone else to take Shiro but in the end all I could do was try to manage what foods he had regularly and take away the dry kibble they snuck him. For a time, it was "good" if not ideal. I tried nearly every day to convince them not to give him dry food but it got to the point where I was sleeping on the streets after "irritating" them too much with that "petty" detail. I was also warned that if I continued to press the issue they would simply send him to a shelter. My city has one of the highest kill rates in the nation for cats. All in all, things were relatively well. His excessive thirst and urination were under control, he was happy and active.

Recently, Shiro began to paw at his mouth and avoid food. The symptoms were very similar to his stomatitis and we brought him in to the vet thinking that it was back. It turned out that the lymph nodes and salivary glands around his neck were horribly inflamed and in a stroke of sheer dumb luck, the vet discovered a mass in his bladder. His bloodwork was normal save for some evidence of his kideys having a hard time (creatinine was normal but I know something was off about them, can't recall precisely what) and of his body battling both a bladder infection and a presumed salivary gland infection - the latter possibly stemming from abscessed teeth. A subsequent ultrasound revealed that the "mass" was most likely a blood clot or a cyst, it was gone by the end of the week after antibiotics and we could just see remnants of it in the ultrasound. However - it appeared that his bladder, pancreas and lower intestines were inflamed as well as his kidneys showing signs of stress. There was also the trademark "thickening" of the walls that indicates IBD, nearly guaranteeing the diagnosis of triad syndrome/triaditis.

This thursday we neutered Shiro, removed the rest of his teeth and have been on Orbax (antibiotic) for about 2/3 weeks. We hoped that the teeth were what was stopping him from eating. Although his gums are healing very nicely and his mouth is not as inflamed - his throat, and likely the aforementioned inflamed/thickened organs are not significantly improved- he began avoiding food as soon as his pain medication wore off. (He was on buprenorphine for the week prior to surgery and was given a fentanyl patch Thursday.) As of late saturday, he looks hungry, approaches his food and backs away in fright. I've had to syringe feed him three times today as i'm concerned about his already-sensitive system collapsing before we can get him to see the vet again on Thursday.

Because my funds are limited, we are likely going to be proceeding in treating his "triad syndrome" under the assumption that is indeed what he has. A significant amount of signs indicate he is and the invasive diagnostics are simply not an option. My vet mentioned "pred" (prednisone or prednisolone she did not specify) as a treatment for the inflammation. However, as Shiro was/is a diabetic I am concerned this might damage his system irrevocably. She also contemplated atopica, but I am worried that his delicate kidneys might not be able to handle that either. Finally, I am concerned that the treatments and dieteary requirements of these three conditions are counterintuitive.

I don't believe Shiro can survive untreated for the triad syndrome. He isn't eating at all, though his mouth pain is significantly lower. If it goes unchecked, even if he does eat, he won't get any nutrition from the food he eats.

My questions are as follows.
(Treatment)
1. Does anyone have experience with a cat who PREVIOUSLY HAD or HAS diabetes using either of the "pred" steroids? I have found lots of information for cats who have steroid induced diabetes but almost nothing in terms of diabetes PRIOR to pred. Would it be a death sentence to give Shiro pred to control his inflammation period; or would lower doses/tapering/a brief round be a good idea?
2. Assuming the pred can be administered, would it be presumptive to assume that we might be able to control diabetic flare-ups with insulin? I am willing to do this if it is feasible but I don't know if it would be.
3. Which, in your opinion, is more critical to treat? the Triad or the diabetes?
4. Same question as #1 but in regards to cyclosporine/atopica. Any experiences with diabetics on atopica, especially with complicating kidney disease?

(Nutrition)
5. The food requirements for both triad and diabetes tend to lean towards low-carb, grain-free, canned or raw food. Assuming Shiro does end up on pred or cyclosporine, raw food won't be plausible due to the decreased immune system. Right?
6. Kidney disease warrants low protein and phosphorous, but triad requires high protein. As it is, i've been keeping Shiro away from gluten and grains (with the exception of the dry kibble that my parents were sneaking him until he had his tooth surgery.) I feed him a rotating set of Fancy Feast Classics canned, Tiki Cat canned (Puka Puka Luau) and Wellness Grain Free canned (core and the "regular" kind). Does anyone whose feline has triad, diabetes and kidney issues have any suggestions as to what alterations I should make to his diet?
7. Are there any appetite stimulant options I might look into for Shiro? I am worried that he's developing a pain medication habit as in theory he should be able to eat just fine right now but is not.
8. Also, he's been constipated for about two days now. Anything I can do for that?


I am fairly certain my vet is going to push an allergen-free dry kibble diet, which I am totally against for obvious reasons. But frankly? I can't afford wet prescription allergen-free/high protein/low phosphorus food either. I have two other cats, one of whom is very sickly as well (chronic Upper respiratory, likely calcivirus, asthma, bronchitis, scar tissue in his lungs) and the other one of whom I must get neutered and have his teeth cleaned ASAP or he will be taken away by the city who can't tolerate the procedure in a mobile clinic and must be carefully monitored. I work for my family and make a very limited amount of money. They are not willing to contribute at all and in this past month alone i've spent about 4 thousand dollars in vet bills, nearly my entire savings. For Shiro's next round of treatments and visits I have resorted to selling my camera, my phone and am looking into selling the very laptop i'm typing on now. I am not eligible for credit or any of the financial assistance things as I am not on any sort of government assistance.

Any sort of help or advice would benefit me greatly. I've spent the past week googling everything I can that has to do with Triad disease but there is very little guidance as far as nutrition or the complicating factor of a comorbid diabetes diagnosis. I'm desperate. Thank you for taking the time to read and advise. As more information becomes available I will update this post or post another reply and link to it. (I am not seeing Shiro's vet until Thursday but frankly I don't think he has that long for me to determine what changes I should make to his diet.)

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

(((((Shiro))))))))))))))sorry no advice just wanted to send prayers and tons of healing green light your way Hugs Kath

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

Wow! You are going through a lot for dear Shilo. I don't have a lot of advice except that I have two older kitties with CRF and I ignore the "low protein" message as I have read enough to believe that that it not as important as lowering the amount of phosphorus. What prompted me to respond here is that I feed my kitties the same foods as the ones you mentioned. Since the Tiki chicken is high Phosphorus, I use a tiny bit of Pho blocker in each serving. They love the Wellness core canned food as well which is low carb and low pho. I also have one CRF cat that will eat Life's Abundance food which is low phosphorus and low carb pate food. She loves it. It is very moist. I like being able to offer another alternative.

I will pray for you and Shilo and hope he begins to eat on his own soon.

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

@Housecats4 - Thank you so much for your kind thoughts.

@RobinCot - From what I've read, the goal for low phosphorus foods is "less than 1%." I admit, I haven't had much sleep this past week and have had a hard time processing what foods are easy on the stomach, low carb, low fat, high protein, grain free and low in phosphorus. And I'm not doing a great job of reading the food charts of commercial foods, understanding them at least. I thought tiki cat was a miracle, Shiro loved it when he ate and it had zero carbs. But you say it's high in phosphorus? Any other recommendations for these specific dietary needs? If the protein is less of an issue, can I ask if you still try to go moderate protein or high/high quality protein?

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

Certainly high quality protein is a must. I think Tiki is a high quality as I can find in a can. I should also add that I feed all my cats home-made raw (recipe from catinfo.org). They love it but the chicken and bone make it very high pho so I also add the pho blocker to that because even with their kidneys slowing down, my CRF cats don't look or act ill. They are very healthy on the raw - soft fur, no vomiting, less hairballs, more active play. I don't want to take that away from them. I use the Tiki and Wellness to subsidize the raw. They are carnivores and their systems were made for protein - I believe. It is very important that CRF cats get lots of hydration. I add water to their food - enough so that they don't drink out of the water bowls. I have water bowls just in case but I usually have to re-fill them only because of the dust that collects in the untouched water.

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

I was certainly considering a raw diet, as I looked over the nutrition information I did find, but I consistently found warnings against feeding raw to a cat with a compromised immune systen, as Shiro would have on both the pred and the atopica. I also worry the switch might be too hard on his gut at the moment. He tried so hard to eat some wellness grain free beef & chicken this morning but had to stop very few bites to try to claw (yes, claw - he is overzealous) at his mouth. Thank goodness for the cone.

You mention a phosphorus blocker. That hadn't been brought up at all, possibly because the results were gone over in a rush or more likely because right now the bigger issue is the IBD and the pancreas being inflamed, but what is it exactly? Prescription, I assume?

edit: as for water. That at least I did know early ok. We have always added water to their soft food, have plenty of water dishes around. Despite this, all three have required fluids for dehydration at some pout or another.

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

You really have a lot of issues to deal with that I am not experienced in. I am in awe of your courage and tenacity with it all. The pho blocker is talked about on Tanya's CRF page (tanya-crf-support) and I have not mentioned it to my vet yet. I got it online - it is a powder - no prescription.

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

It is possible to get a recipe for a home cooked diet, too. That would handle the possible issue with feeding raw.
One resource is the Ohio State University College of Veterinary Medicine. I think your vet would need to contact them and of course they probably charge for it.
Another is Dr Pierson of Cat Info. She may be able to adjust the raw recipe from her website.

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

I'm certainly gong to consider trying to get a recipe for some cooked food when my budget allows. Unfortunately, right now all three of my cats are in and out of the vet for one reason or another so money is tight and I'm mostly looking into finding an available variety of Low/No Carb + Low Phosphorus foods with high quality protein. Shiro's really prone to getting tired of certain foods and there are concerns about him managing in the short-term given that he just had a full mouth extraction. If you don't mind, Robin - let me know what your vet says about the phosphorus blocker?

 

Re: (Long post) Triad Syndrome and Diabetes - What to do? Fe

AvalonWitch, it sounds like you and I have cats that are in the same boat! Shadow is 20, and likely suffers from triaditis (we have an ultrasound scheduled for next week to possibly confirm the diagnosis), very newly diagnosed diabetes, stage 3 CRF and a handful of other issues we are currently managing. We also have a consultation with a veterinary nutritionist scheduled to discuss a homemade diet. I would be happy to share what I learn, if you promise not to hold it against me if it doesn't work for your Shiro. I should have more info next Tuesday. (I'm new to the board, by the way, but your situation sounds so much like mine that I felt this was as good a place for an intro as any! :smile: )

Oh, and the constipation? Also an issue I deal with in Shadow. He gets 1/8 tsp of Miralax twice a day to control that. If he hasn't had a BM in over a day and a half, I bump it up by another 1/8tsp. It's a dose to effect sort of treatment with a high margin of safety if you are certain that your cat is only constipated and doesn't have an obstruction. You may want to start at a lower dose. Here's a link to a site with more info on how to use Miralax for cats: http://www.vetinfo.com/miralax-for-cats.html#b