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Hi all,

My first time here - came here to hopefully get some good advice!!

I brought my 13 year old boy Orville into the Vet a couple weeks ago to get him checked out, as he'd lost a bit of weight recently and wasn't eating all his breakfast. Had the vet do blood work, urinalysis and an ultrasound. the Blood and Urinalysis came back ok (except for slightly elevated kidney levels) but the Ultrasound was in-conclusive. He either has IBS OR mild/early stages of Lymphoma. I could take him to an internist for a biopsy (spending a bunch more money in the process) but am trying to avoid that for the time being. he may eventually go on a steroid but I'm told that could aggravate his kidneys. so for now, the Vet prescribed him Science Diet Z/D wet and dry food.....it's expensive but he seems to dig it (especially the dry). the wet food is a bit dense and gelatinous and I read some reviews online where many people said their cat wouldn't eat it (but would eat the dry). I've added a dash of Tiki Cat tuna to make it more palatable and exciting for him.

anyway, my question is: is there an alternative to Z/D or am I stuck with this forever? I should also mention that Orville has a twin brother so whatever I feed one cat, I have to feed two. I sometimes feel like the vet hospitals maybe have some special deal with the food companies to exclusively sell that one brand of food.

I'm including a photo of my sassy Coons (Orville on the left, Wilbur on the right).

thanks in advance for any advice you all might have!

Dina
 

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Hi Dina,

Aw, what gorgeous boys you have!

As for the z/d, I believe it's the only commercially available hydrolyzed protein diet - which is not to say that it's necessarily the only thing that might help Orville.

Before you resign yourself to having to pay for it forever, I'd fully explore other possibilities, because IBD is not a go-to diagnosis; it's what's left over when no other condition can explain what's going on. Another member, MowMow, just learned that one of her kitties was misdiagnosed with IBD years ago. You might find it interesting to read her experience: https://www.catforum.com/forum/38-health-nutrition/394488-long-time-no-chat.html

Do you know whether the ultrasound was read by your vet or by a radiologist? If it was your vet, I would ask for the imaging to be sent to a qualified radiologist for a detailed report.

The other thing that comes immediately to mind is pancreatitis; two common symptoms are lack of appetite and weight loss. Did the bloodwork include a Precision PSL (if the lab was Antech) or spec fPL (IDEXX)? Pancreatitis seems to be underdiagnosed, and many kitties with chronic kidney disease also have pancreatitis, so if Orville has early stage CKD, it's worth it to test for it.
 

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thank you so much for REplying Spirite! yes they are very handsome :D

the person who did the Ultrasound WAS a radiologist - I know this because he only comes in a couple times a week to my vet hospital and I had to schedule his appointment around that.

the vet didn't mention anything about pancreatitis and Orville most *definitely* has an appetite. he is chomping at the bit for his brekky in the morning! but I might call the vet and inquire about that - as she didn't mention anything about that at all.

the litterbox has been getting a LOT more action it seems - I wonder if the food is causing that?

I am considering putting out the feelers for another vet and maybe taking him in for a second opinion. Of course I could get the biopsy, but I am trying to avoid putting him through that if I don't have to (as well as the cost). I'm not even sure what that entails? (does he need to be sedated? how invasive? etc etc).

For now he seems to be doing okay, I am watching him like a hawk for any changes in his condition. I just can't believe there aren't other food options out there!?!?
 

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Hi Dina,

Just a quick note right now as it's way past my bedtime, but a good appetite with weight loss could be hyperthyroidism. Was his thyroid checked (T4 test)?

And when you say the litterbox is seeing more activity, do you mean pee? What was his urine specific gravity?
 

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Hi again Dina,

Your vet probably didn't mention pancreatitis either because Orville isn't necessarily showing some classic symptoms, primarily abdominal pain on palpation or because nothing was flagged on bloodwork or ultrasound. However, the reasons I mentioned it:

1. His decreased appetite. Is he showing any signs of nausea, like lip-licking, or going to the food bowl and then walking away, that would explain it?

2. Bloodwork won't necessarily tell what's going on, especially if it's chronic pancreatitis, not acute. Kitties with chronic panc have flare-ups and periods where they do well. At those times, bloodwork may come back normal.

3. I believe (but I'll double-check) that an ultrasound can tell you if there is pancreatitis but can't rule it out.

4. It seems that pancreatitis is very underdiagnosed. It is very common in cats with concurrent chronic kidney disease, and Orville's kidney values are elevated. My vet didn't even bother testing my advanced CKD kitty; he just assumed that she had it and treated as if she did.

If he continues to eat less, lose weight, starts vomiting, or shows signs of nausea or of pain (withdrawing, growling, not wanting his tummy touched), I'd bring him in, and if the vet doesn't suggest testing for panc, ask for the spec fPL (not the Precision PSL).

I know that you didn't ask about any of this, but with the food question, and Orville showing signs of early CKD, it's important to know if he has pancreatitis and/or hyperT. The tests only require a blood draw so are less expensive and less risky than a biopsy (which will require anesthesia and will be, to some extent, invasive). And those conditions may change what the best diet would be.

If it is IBD, you might consider is a raw diet. That's worked well for some kitties with IBD or other GI issues.
 

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thank you again for your very thorough reply! I have a call into the vet and will hopefully be able to ask about the thyroid/pancreas/kidney. with his increased litter box usage (not sure what you mean by "urine gravity") the receptionist I spoke to said it could be concerning as they are worried about possible renal failure. he is definitely in there more and more but hard to really pinpoint since he shares the box with his brother.


I haven't noticed any diarrhea and the vomiting is not out of the norm - I have puke-y cats. they love to guzzle water out of the bath tub (especially in the morning when we're all in the bathroom getting ready) and then eat their breakfast - which causes them to sometimes puke up their breakfast. GAH!
 

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Hi Dina,

It's great that they like to drink water! Keeping hydrated is really important with kidney issues. And it's also really good that there's no diarrhea. When they vomit in the morning, is it undigested food, soon after eating? If so, that's stomach acid, which builds up overnight, so when kitties are very hungry and eat too quickly, it all comes back up. You could try splitting their evening meal so that they always have a little something before bedtime.

I would ask the vet for copies of all labwork results; it's always best to keep them yourself so that you can track any changes over time. This is especially important with senior kitties that have health issues, who will likely be having more frequent tests.

On the results of the urinalysis, you'll see urine specific gravity, or USG. That number tells you how well the kidneys, which normally flush out toxins, are working. When function declines, the toxins build up, the body wants more water to get rid of them, so kitties drink more water, then pee more, but the urine is more dilute because there's more water in it. That's what USG measures. That number is used, along with BUN and creatinine (on bloodwork) to diagnose kidney disease. Normal USG is 1.035 and up.

Looking forward to hearing what the vet says!
 

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thank you so much for all that very helpful info! I think it's a good idea to get copies of the lab results at some point. I did speak with the vet yesterday and she recommended that I keep with the Z/D food for at least 2 months to really see results - and it's only been 3 weeks, so.....he seems to be good so for now I think i'm going to try and not worry.....and just keep monitoring his weight and everything else :) This morning he ate ALL his wet food in one go so that made me happy!

I did mention getting his B12 tested and she acknowledged that was a valid point but the test is $200 and I think I will table that for now.

and yes - usually when they puke in the morning it's their food they just gobbled up :serious:

I will update here with any news!!
 

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I'm so glad that he's eating well! The most important thing is always that kitty is doing well. Tests and numbers are all always secondary to that. :)

It makes good sense to stick with the one diet long enough to see whether or not it makes a difference before you try anything else. If you start changing a bunch of things, then you don't know what's working and what isn't.

Puking up undigested food is technically regurgitation - try giving them a bit of food before you go to bed. That would probably put an end to it.

Wishing you well and hoping that the next update is just as positive! :)
 

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okay here is his Urine Gravity test results - that appears to be normal too:


Color Dark Yellow
Appearance Turbid
Specific Gravity (results) 1.028

Normal Range: 1.015-1.060
pH 6.0 5.5-7.0
Protein 2+ Negative
 

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Argh, my post disappeared.

Anyway, glad the T4 came back normal and that he's eating the z/d. The plus is that z/d is low in phosphorus, which is important to slowing kidney disease. I've heard that the texture of the wet is really weird, but it would be good if you can get him to eat as much wet as possible.

Ok, so Orville's urine specific gravity does show early kidney disease but isn't too low yet, and urine color shows he's still concentrating urine pretty decently.

The result for protein has to be either 2+ or negative. Is negative the reference? 2+ could indicate proteinuria, but if the vet didn't mention it, then I'm sure it's nothing to worry about.

Sounds like you're doing everything to keep him as healthy as you can!
 

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hmm...it also says this:

Urine protein:creatinine ratio testing is recommended (if the sediment is inactive) to help determine the clinical significance of proteinuria.

not exactly sure what this means?
 

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Hi SFGlam,

My kitty had the same result once, and despite that comment on the results and the fact that she was already stage 3 CKD, my vet never mentioned it. Now that I know much more about CKD, I wish I had asked for the UPCR test.

The UPCR test will confirm or rule out proteinuria, which means kitty is losing protein in the urine (due to decreased kidney function). It's important to treat it because it can make kidney disease progress faster, so I would definitely ask your vet to have the test done. I don't think they could run the test on the urine sample they have though, so you'd need to bring him back in for another urine sample.

If he does have proteinuria, treatment is just a pill, usually benazepril or Semintra.

If you're interested, there's a lot of information here: https://www.felinecrf.org/proteinuria.htm

Hope that helps!
 
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