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Possible Stomatitis Related Appetite Issues

DavidJ

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Tilly is a 9 year old feline female neutered Tonkinese. When she came to live with us 4 years ago, she had had all her teeth extracted due to stomatitis. Her mouth is completely healed. She may have herpes, as she has chronic clear discharge from her eyes and nose.

She has been tested for food allergies/sensitivities. The test revealed she is sensitive to beef (cow, buffalo and bison), chicken, corn, soy, cow milk (strong reaction), oatmeal, peanut and peanut oil (strong reaction), potato (strong reaction), quinoa (strong reaction), rice (strong reaction), salmon and salmon oil and sweet potato. From this test, recommended “safe” foods are duck, lamb, goat, goat or sheep dairy, pork, turkey, white colored fish and rabbit. (Note she does not seem to like white colored fish, however). She has been eating either Instinct wet Turkey Limited Ingredient Diet or Wellness Core Smooth Turkey and Duck Recipe.

She currently takes quite a long time (45 minutes to 1 and a half hours) to eat, with constant attention and encouragement, 1.4 ounces of food in the morning and in the evening. This slow eating started about a month ago. Before current eating pattern she ate about 1.95 ounces of food twice a day.

In the last several months, she has lost a pound in weight. She is a small kitty, and now weighs 6.4 pounds, perhaps a good weight for her if we can maintain it. We recently started adding Nutri-Cal to her food.

According to the vet, her blood work looks good, with the exception of creatinine being high (3.1 mg/dL) and phosphorus a bit low (2.8 mg/dL). Her free T4 values look good. (Blood work can be supplied if desired.)

When she is congested, she likely cannot smell her food well. Lately we have been giving her 1 mg Chlorpheniramine Malaate crushed in her food to help with her sinuses. This seems to have greatly helped with her constantly running eyes and nose and congestion, but we are concerned about long term use and her hydration. She appears dehydrated. We mix about 5 teaspoons of water into her food to supplement whatever water she gets from the food. We do not see her drinking from the waterdish.

Twice in the last 6 months, we tried giving her Hills Z/D. After a couple of days, her congestion was worse and she did not want to eat. Apparently hydrolyzing the constituents of Z/D was not enough to counter her food sensitivities.

She was taking ¼ ml Azithromycin in oil by mouth twice a week to help control overall chronic symptoms. She is no longer taking this. We continue to give her 1000 mcg of vitamin B12 twice a month.

We tried mixing powered Lysine into her food. As with the case of a littermate, this seems to induce vomiting clear liquid. Without the Lysine, she does not appear to vomit.

She has lost a bit of her playfulness, which we greatly miss. She remains very loving.

We are looking for suggestions to address the chronic underlying cause(s) for her congestion, running eyes and runny nose. Could these issues be a result of her previous stomatitis?
 

Dr. Jean Hofve

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If the issue is an unresolved aspect of stomatitis, a trial of pain medication would tease that out; that might be one avenue to try.

Allergy tests in cats are notoriously unreliable, but if you're finding that her symptoms correspond to the named foods, then she might be one of the exceptions!

Nutrical is a problem for me. The first few ingredients are Corn Syrup, Soybean Oil, Malt Syrup, Water, Fish Oil, Cane Molasses. There are three forms of sugar in the top five ingredients (water doesn't count). Corn and soy are both GMO and loaded with glyphosate, a toxic herbicide (Monsanto's Roundup). That said, the best way to put weight on an animal (or human!) is to eat lots of sugar and/or simple carbohydrates.

The fish oil in Nutrical is okay *if* it's a clean source, but since it doesn't specify, it could contain salmon so... maybe use a sardine/anchovy oil like Nordic Naturals, or green-lipped mussel oil like Moxxor (a milder taste, if she is not so keen on fish).

There are liquid lysine supplements, if you want to give that another try. Look for one with the tiniest pysical volume per dosage. 1000 mg a day is needed when symptoms are present. But of course, she's a cat, so start with the teeniest-eeniest-weeniest possible drop, and very gradually increase.

Hydration IS a worry for these guys. It's laudable to add water to her food, OTOH I know a lot of cats who just won't eat it when there's too much water (including my cat). It makes the food lose its taste and smell. Also, not to rain on the parade, but at her weight she needs 6 oz of water per day, which is 36 teaspoons. The food has some, but she is probably dehydrated, given her BUN--and that can definitely impair appetite. BUN is essentially ammonia. Having once been the victim of an ammonia leak at the dairy behind my house, I can tell you that the headache it produces is like having an ice pick jabbed between your eyes! Maybe consider learning how to give subcutaneous fluids at home. In my 27 years as a vet if there's one thing I've learned, it's that fluids can improve almost everything that can go wrong with a cat!

Certainly constitutional homeopathy would be the way to go for an ultimate cure!
 

Dr. Jeff

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Thanks for your wonderful posts, Jean and David! Welcome to HA! David, and I'm so sorry for the delayed reply and to hear about Tilly.

Tilly's poor appetite, loss of playfulness, low energy and decreased environmental engagement are typical for pets with a very low BEAM (Behavior, Energy, Appetite, Mood).

Here's the use of BEAM in the case of skin allergy symptoms:


The good news is that if there is no structural change and if Tilly's vitality is sufficient, she can self-correct quickly. All you need to do is use the Happiness Protocol to increase her cellular energy and ability to heal.

The not so good news is that her 3.1 creatinine may reflect that she does indeed have early kidney structural changes (2.4 is usually the upper limit of normal). Her low phosphorus in fine. In fact, cats with CRF usually have elevated phosphorus levels.

You might want to ask your vet to trend her BUN, creatinine, albumin, and hematocrit over the past year or two to see when her renal insufficiency (kidney problems) began.

Trending is a method of comparing blood results over time. It gives much better context than individual results.


Regarding her allergies, I agree 100% that the diagnostic tests are not very reliable. 6 week food trials are still the gold standard for food allergy testing.

As a "side effect" of treatment for her immune balance, I'd expect her allergy symptoms to resolve (gradually). The allergic state is one of immune hyper-responsive to common triggers which worsen as energy decreases but also improve as cellular energy improves.

Also, for anti-viral immune boosting, I would consider using something like Liquid Immuno from Rx Vitamins in place of plain lysine.

We are looking for suggestions to address the chronic underlying cause(s) for her congestion, running eyes and runny nose. Could these issues be a result of her previous stomatitis?

1. Get her kidney dis-ease IRIS staged by an internist. That will also help us formulate a game plan for improved eating and energy.


2. Read the terrain and susceptibility blogs and start practicing the Happiness Protocol by promoting:

  1. petting
  2. purring
  3. playing


3. Cultivate her inner terrain to get her into tip TOP (Terrain Optimizing Protocol) shape:
top.png

4. Please keep us updated about Tilly's improvements on the forum and/or during Monday Empower Hour! webinars.

Good luck David.
 

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