Sassy and her Co-morbidities
Last week we posted a story about a dog named Calvin and how we had to try to juggle his various medical problems to come up with a treatment plan. This time we have a story about a pet named Sassy, who has even more medical issues than Calvin does.
Sassy is a fifteen year old cat. Like Calvin, she has bouts of poor appetite and vomiting, so she probably has inflammatory bowel disease (IBD) or food allergy or both. Her owner cannot afford surgical biopsies of her intestines to find out for sure so we are making an educated guess about this.
Sassy also has bladder inflammation that requires a special diet different from the hydrolyzed protein hypoallergenic diet that would be best for her digestive system. To add to the problem, Sassy is pre-diabetic. For diabetes management, Sassy is currently eating a low carbohydrate and high protein diabetes diet. The hydrolyzed protein diets are the opposite of that; instead, they are low in protein and high in carbohydrate. We have a combination diet that has hydrolyzed protein and decreases bladder stone risk or one that combines diabetes management with bladder stone prevention but we don’t have a diet that does all three. If we switch to a hydrolyzed diet we will likely tip Sassy over the edge and make her diabetic, at which point she would need to start insulin injections and intensive diabetes management – which is expensive and has its own set of risks and difficulties. If we choose the food for diabetes management plus bladder stone prevention her appetite will probably continue to be poor because we won’t be addressing her intestinal inflammation.
To further muddy the water, Sassy has kidney disease and high blood pressure. (Nearly every cat her age and older has some degree of kidney disease and many develop high blood pressure because of it.) Diets made for kidney disease are low in sodium to help the high blood pressure and are also pretty good for preventing bladder stones - but they are not hypoallergenic and they are low in protein and high in carbohydrate, so once again feeding that will increase her risk for diabetes.
In Calvin’s case, we wanted to start prednisolone in order to treat IBD and improve appetite. Sassy is already on prednisolone to help her appetite and to treat presumed IBD but her appetite still isn’t good. She isn’t eating enough of her regular diabetes diet even with the pred in her system so it may be difficult to switch her to a different food. He owner is mixing cheap canned grocery store food in with the diabetes diet, which is probably making both her bladder and her intestinal problems worse and is terrible for her kidneys. To make matters worse, steroids like pred increase blood sugar levels and the risk for diabetes.
So what food do we choose for Sassy and what should we do about the steroid she is taking? And what food is Sassy most likely to eat? No diet made to solve a medical problem will work if the pet won’t eat it!
Sassy is scheduled for a bladder x-ray in a few days. If she has bladder stones, the food she eats becomes even more critical. We are thinking we will switch Sassy to the diet that works for both diabetes and bladder stone prevention, hoping she will like it enough to eat it. If she doesn’t, we will probably add an appetite stimulant. Someday soon, we will likely need to add additional medications for kidney disease since we won’t have the luxury of using a special diet for that problem. It is likely that we will continue to struggle to keep all Sassy’s problems under control and eventually, one of them will advance to the point that we can’t maintain her anymore. For now, we are hopeful that we can keep her eating and keep juggling.