3/29 - Mr Kitty - "Treatment Triage"

FrostD

FrostD

Member Since 2020
Last post

@Wendy&Neko @Suzanne & Darcy @Katherine&Ruby @Christie & Maverick

This is me thinking out loud, but trying to prioritize/balance all his conditions and meds, seeing if anything jumps out at anyone:

Acromegaly - currently treated with cabergoline, 5mcg/kg every 1.5 weeks

HyperT - will begin methimazole 1.25mg q12h whenever it comes in. Methimazole in humans can lower efficacy of cabergoline, but we have a lot of room to increase cab if needed

Unmasked CKD - based on lab values and just my general "luck", treating hyperT will unmask CKD. Some reading revealed some cats on methimazole go straight into renal failure/acute kidney injury, so that's a nice prospect :blackeye: I am proactively going to move him to a low phos low carb food this week before starting methimazole

IBD/SCL - biopsy not possible due to anesthesia issues, stool has alternated between pale and diarrhea so I think it's time to treat
  • Considered novel proteins, but low carb + low phos + novel protein commercial food doesn't really exist. Raw just isn't feasible at the moment for a number of reasons...so I think it makes more sense to prioritize kidneys?
  • Originally planned pred, but two problems - it could kick the diabetes back into action and I have QoL concerns with that on top of everything else (it feels too much for the poor guy with testing/shooting/meds/bringing him in for his labs)
  • Budesonide seems the better option, but downside is it's metabolized more heavily in the liver than pred...and his liver values are already elevated...though there is some hope those will come back down with treating the hyperT.
  • With either medication, at least the stuff documented in humans since there isn't a lot of data for cats, methimazole can reduce efficacy of them...but both of them can increase cab efficacy, so at least it's not all bad

My head hurts. He's sitting here next to me purring away of course :rolleyes:
 
Hi Melissa, wondering if phos binders might be your friend in this instance? I think you usually start feeding with binders when phos is above 6, and Mr Kitty isn’t there yet, but you may consider adding it to say a ZiwiPeak rabbit or venison. Do the novel protein trial with binders before you do steroids, just to see if that makes a difference. Can’t really comment on the hyper T stuff because I have zero experience with it. Big hugs, cat mamma. You’ve got a lot on your plate!
 
Katherine&Ruby said:
Hi Melissa, wondering if phos binders might be your friend in this instance? I think you usually start feeding with binders when phos is above 6, and Mr Kitty isn’t there yet, but you may consider adding it to say a ZiwiPeak rabbit or venison. Do the novel protein trial with binders before you do steroids, just to see if that makes a difference. Can’t really comment on the hyper T stuff because I have zero experience with it. Big hugs, cat mamma. You’ve got a lot on your plate!
Click to expand...
That crossed my mind too, wasn't sure if they were "appropriate" to use yet, since most things I saw said above 6 like you said. Also not sure how amenable he'd be to it mixed in food but, well, I'm as stubborn as he is most days :smuggrin:

Thanks! This part is always a little disheartening, when the issues start to pile on and QoL starts to factor in :/ but, he's a happy purry kitty for now, one day at a time
 
FrostD said:
low carb + low phos + novel protein commercial food doesn't really exist
Click to expand...
Sure it does. I made my own with the EZComplete premix which makes it low carb and low phos. Just added choice of novel protein. Neko got bison, buffalo, elk and a few other things I could find. Actually, I first used TC Feline special premix that is designed to be low phos and even has calcium carbonate in it (a phos binder). But you have to watch calcium levels and I'm not sure you can get it in the US.

Also remember, novel protein is what is novel to him. Has he ever had lamb, venison, quail, duck, pork? Merrick LID duck is low carb/low P - it says higher carb on Dr. Lisa's list, but I think that is wrong. It didn't bump Neko's numbers at all.

Commercially, there are a few vendors not on Dr. Lisa's list, Rawz, Identity, Dave's Restricted Diet that should be checked out.
 
FrostD said:
That crossed my mind too, wasn't sure if they were "appropriate" to use yet, since most things I saw said above 6 like you said. Also not sure how amenable he'd be to it mixed in food but, well, I'm as stubborn as he is most days :smuggrin:

Thanks! This part is always a little disheartening, when the issues start to pile on and QoL starts to factor in :/ but, he's a happy purry kitty for now, one day at a time
Click to expand...

Hi Melissa and Mr Kitty,
I had also heard to use binder when phosphorus reached 6, but my vet wanted to start a binder when phosphorus was over 5. The binder can be constipating, so use caution in that regard.

One day at a time, yes. And it is great you are looking out for, and care about QOL.
CONGRATS on your new little life!!!
 
Dear Melissa and Mr. Kitty,
Eddie and I just dropping by to add a few more :bighug::cat::bighug:.

"My head hurts": I so understand moments like this. At times I feel like the aerialist, Nik Wallenda, who crossed Niagara Falls a few years ago by walking along a cable stretched from the US to Canada side holding only a balance pole and putting one foot after the other.

Wishing you and Mr. K all the balance in the world.
 
It’s so hard when kitties have so many diagnosis. I will say that the novel protein diet has helped Max. So has the Budesonide. I also use the EZ complete mix and make food, what Wendy mentioned. Max likes variety. I’m sure you will figure out what’s best for Mr Kitty, but I do feel your pain with managing multiple things. I hope you are feeling okay. Early pregnancy also has its side effects as I’m sure you know. I worked in obstetrics for years. Take care of yourself. Hope you are well Melissa! Good luck.:bighug::bighug::bighug:
 
FrostD said:
Some reading revealed some cats on methimazole go straight into renal failure/acute kidney injury,
Click to expand...
Yes. I have also read about this happening. I read that sometimes it is better to not treat/under-treat the hyperthyroidism to aid the kidneys. What a balancing act!
 
FrostD said:
though there is some hope those will come back down with treating the hyperT.
Click to expand...
Sorry, I'm taking this point by point. Also sorry, I didn't see this yesterday... just now trying to catch up for a little bit.

But yes, liver values like ALT can improve with treatment for Hyperthyroidism. But then you've got the kidney issues. Are we going in circles here?
 
Wendy&Neko said:
Merrick LID duck is low carb/low P - it says higher carb on Dr. Lisa's list, but I think that is wrong.
Click to expand...

I was dismayed to find that Merrick has changed the formula for this LID Duck (after I bought a case, of course). The phosphorus has gone way up. It also isn't great quality protein in there since it contains pea protein (third ingredient on the list after duck and water. Here's the information that I have for it now:

Merrick Limited Ingredient Duck: phosphorus 1.74% DMB (more than 300% higher than previous number!)

Whole Earth Farms Chicken Pate: phosphorus 1.37% DMB (about a 80% increase since last time)

I know you aren't looking at the Whole Earth Farms Chicken Pate either Melissa... I just threw that one in there because a lot of people here feed it.

My cats, of course, like the Merrick duck! I only give it as a food topper (to get rid of the case).
 
FrostD said:
Unmasked CKD - based on lab values and just my general "luck", treating hyperT will unmask CKD.
Click to expand...
Also, if we are worried about current "masking" then a look at the USG would have been beneficial and give you a more accurate picture. Maybe you can catch some? Since Mr. Kitty is notorious for letting it loose at the vet, right?
 
Suzanne & Darcy said:
Also, if we are worried about current "masking" then a look at the USG would have been beneficial and give you a more accurate picture. Maybe you can catch some? Since Mr. Kitty is notorious for letting it loose at the vet, right?
Click to expand...
I can just get a clean catch and bring it in when I pick up meds.

Believe me, for a fraction of a second I debated not putting the usual pee pad in the crate, so they could just dump it out :oops: they went through 7 towels last visit....
 
Suzanne & Darcy said:
I was dismayed to find that Merrick has changed the formula for this LID Duck (after I bought a case, of course)
Click to expand...
Sigh! Either Merrick, or the owner Purina playing with the formula. :( Just looked at the LID Turkey which used to be a winner here and of course they've changed that formula too. Which explains why it's now considered trash. After I scored a case when I hadn't been able to get it for months. :rolleyes:
 
Wendy&Neko said:
Sigh! Either Merrick, or the owner Purina playing with the formula. :( Just looked at the LID Turkey which used to be a winner here and of course they've changed that formula too. Which explains why it's now considered trash. After I scored a case when I hadn't been able to get it for months. :rolleyes:
Click to expand...
It is purina. They played with all their sub brands and changed formulas over last few months. I urge everyone to check any purina branded food...pro plan, friskies, fancy feast, and now of course the Merrick now too! The sad thing is they are changing ingredients and telling no one. Listing nothing of the change!
 
Rainbow Conti said:
It is purina. They played with all their sub brands and changed formulas over last few months. I urge everyone to check any purina branded food...pro plan, friskies, fancy feast, and now of course the Merrick now too! The sad thing is they are changing ingredients and telling no one. Listing nothing of the change!
Click to expand...

:mad:
 
You must log in or register to reply here.
Back
Top