Consistent undereating—how long is too long?

I posted this in the Cat Health part of the forum, but thought this section might be more appropriate. My cat was diagnosed with CRF about a month ago after coming home from a tooth cleaning and vomiting/diarrheaing for a week afterwards, and I'm working on transitioning her from dry (Orijen) to wet (Kattovit Sensitive). She hasn't been eating much (the vomiting/diarrhea have cleared up, though), and I've been recording her calorie intake for the past couple weeks and it's really low. It hovers right around the 160 kcal/day she needs to get 15 kcal/lb and not have hepatic lipidosis—only once or twice a week has she been getting close to weight maintenance calorie levels (250 kcal/day), and about half the week she's between 120-140 kcal/day.

Does anyone know how long she can keep eating like this before serious problems (like deficiencies) develop? Should I be giving her vitamins?

Her calorie intake has been low on and off for the past couple months. She hasn't visibly been losing weight, but she's not very active, either, and spends most of her day sitting on or near the radiator. (She'll play if she doesn't have to get up to do it...)

(The original thread I posted in Cat Health is here: http://www.thecatsite.com/t/295125/yo-yo-dieting-cat-hepatic-lipidosis-risk )

@samus -- may i ask how old your girl is? and, is your girl being given sub-q fluids?

When was her last weight check?

I see you are trying to get her off the dry food and onto wet. Is her low cal intake a result of this? Does she seem to like the canned food? What about looking into a higher calorie food?

In the meantime, you could get some NutriCal to help supplement.

I also advise contacting your vet to let them know about your concerns if you haven't already. They may want to get her on an appetite stimulant or possibly check her for pancreatitis.

"Approximately 2 weeks of eating 1/2 - 3/4 the normal

amount of food is needed to develop a fatty liver."

"The average cat with lipidosis is middle-aged, was at one time obese but has lost at least 25% of its original body weight, has a poor appetite, and may have an obvious upset stomach (38% will have vomiting, diarrhea or constipation). Cats that are especially weak may have concurrent electrolyte imbalances or vitamin deficiencies from their liver disease."

http://www.veterinarypartner.com/Content.plx?A=1455

She's 12, and isn't receiving any sub-q fluids. The vet's only recommendation for dealing with the CRF was "we have some food we can sell you."

Her weight was last checked around the end of February (when she was brought to the vet and diagnosed with CRF).

Her low calorie intake started in January, when I brought her to Germany (before that she'd been living with a friend for a year, so I'm not exactly sure what her "normal" had been for that year). She was having a little vomiting and intermittent diarrhea or blood on her poop, I brought her to the vet and she expressed her anal gland which was gunky and said that was probably the issue, and it did seem to be part of the issue because her hair at the base of her tail grew back and she started eating a normal amount and having normal poops (still with a little streak of blood from time to time) after about a week and a half. I also threw out the baggie of food my friend flew over here with and bought a new bag (same brand), she seemed to think the new food tasted a lot better. At this point she was active and playing and everything seemed fine.

A month after the first vet visit, I brought her back to get her teeth cleaned (for the first time ever) and double check on her anal gland. The vet said the anal gland looked ok and went ahead with the dental, and when she got home she was out of it for a day, then was barely eating, but drinking water and vomiting it up for a week. Her diarrhea was pretty bad and smelly, so I brought her back to the vet who did a blood test. The vet gave her some sub-q for dehydration. I asked about the blood on the poop again and she didn't think it was an issue, my impression was she was saying the anal gland was still healing and it was a side note to her real problem, which is kidney issues. (Her English wasn't perfect and she had to get the vet tech to translate to her a few of the things I was saying.)

The kidney test showed slightly elevated creatinine, normal BUN. According to charts on Tanya's CRF site, she's just barely in stage 2 by her creatinine value. Everything else was normal except for eosinophils, but when she was at the vet the first time in January she was checked for parasites. I think she's had food allergies for a while, she's had high eosinophils before and the vet then couldn't find any other cause.

So I started trying to switch her to wet food. My options are restricted because I am trying to limit protein sources so that once she's off the dry food, she's only eating one protein, and because I'm trying to stick to foods with low phosphorous for the CRF. She likes the Kattovit a lot better than the fish based wet foods I was trying before (each of which she would eat for a day and then never again). For about a week and a half after the last vet visit, she was still spitting up, but making sure there's always food out seems to have stopped that (so she can snack throughout the day). She was also hunching in a loaf after eating before, and that seems to have stopped.

Basically all the symptoms from before have cleared up at this point: no visible blood on the poop, which is solid. No vomiting for about three weeks. It's hard to tell if she's drinking more than normal because I bought a fountain, so I don't see the water level change as well as I did with a water bowl. I do add water to the wet food, and I see her drinking from the fountain (especially after eating), so I don't think dehydration is an issue. She's still not very active, she had a good morning about a week ago when she was chasing some hair ties around but then went and "loafed" for a little while.

She's not super into wet food, I have to add water and flip it over or mash it every so often so she has an unlicked side to eat, which I can't do very much on weekdays because I'm not home most of the day. I have been adding Fortiflora and that usually gets her to eat more. Catnip also seems to make her less picky, but I'm not sure how much I should be using it if she might be having liver stress.

@samus -- thank you for a really good amount of info! it really does help us, knowing more info rather than less.

my snick has CKD, also in stage 2. i understand that each cat is different and treatments are based on their individual needs, but i would strongly suggest discussing with your vet giving your girl sub-q fluids on a regular basis. you can either have the vet give the fluids or you can do it yourself at home. i give my snick fluids at home every other day, and i've given her the same amount of fluids (150cc's) at the same frequency (every other day) for (i want to say) at least two years. sub-q fluids will help by flushing out the toxins that your girl's kidneys aren't able to filter out on their own now (with her CKD/her kidneys having significantly reduced function). helping your girl's kidneys by giving sub-q fluids can slow down the progression of her CKD, and can keep her feeling better for longer. a nice side effect of sub-q fluids is that many or most cats have increased appetite right after they've gotten the sub-q's. my snick goes over to her food dish immediately following her sub-q's and eats well, every time.

i've found that i need to be very proactive about my snick's care and treatments. i ask questions and discuss concerns and options with my vet on a fairly regular basis. it helps that i have a very good vet, who is 'on top' of everything -- she knows what she's doing.

a little while back my snick had some serious gastro upset -- snick also has IBD. snick had very bad vomiting and couldn't even keep water down at one point. i was working with my vet on treating this, and she suggested fasting snick to allow her gastro system some time to calm down. there was a risk of hepatic lipidosis (fatty liver disease), so my vet suggested giving snick her sub-q's every day until we were past the immediate crisis and snick was eating well again. my vet said that it's possible for the sub-q's to delay/prevent the development of fatty liver temporarily -- in some cases. in my snick's case, she did not develop fatty liver disease, her gastro system did calm down, and she was able to work back up to her normal food intake.

we've also used the sub-q's to flush out the (bacteria from the) very beginning of a(nother) urinary tract infection with my snick. so, the sub-q fluids have more than one possible use for CKD cats.

you'll see there on tanya's CKD website that there are options for buying your own sub-q fluids supplies, which is what i do. i save money by buying my own supplies, which has helped me have more money available when something medical comes up with my snick. i think it's worth considering buying your own sub-q fluids and supplies and giving your girl sub-q's at home. if you've never given sub-q's and are concerned you'll have problems doing that, there are videos at tanya's website on how to give sub-q fluids and there are members here who can help while you're getting used to giving your girl the sub-q's.

so i would suggest discussing these things with your vet. i always make a list of the things i need to discuss with the vet, because once i'm there at the vet office i'm concentrating on my snick and her comfort and it's very easy to forget some of my questions or things i wanted to discuss with the vet.

Thanks for that advice, @mickNsnicks2mom . I've been thinking of the sub-q fluids as a "last resort" type of thing and the idea makes me a little queasy. (I also had some medical issues where I was getting IV fluids pretty regularly, just thinking of that plastic taste in the back of my nose makes me feel sick.) But if it's something that will keep her feeling better for longer, I'll have to look into it. Being in Germany complicates things a lot, and I don't have a whole lot of extra money to go vet shopping (competent, good English, and has a good rapport with me and my cat—pick any two).

I am worried a bit about pancreatitis, but I think IBD is more likely. I've been giving her aloe juice in her food and I think that might be part of why she looks less in pain when she eats, she goes in her box and grooms now after meals instead of hunching up under my desk with a little mohawk. That's part of why I'm so determined to get her off the dry food and get her on a new protein, but I think I'm going to just free feed dry along with the wet for a couple days to make sure she gets adequate calories. I wish I could find a good plain chicken baby food here!! (I've looked in five different groceries already!!)

Dr Katherine James of the Veterinary Information Network believes that this tends to happen and that most CKD cats will benefit from subcutaneous therapy once creatinine levels are consistently over 3.5-4.0 US (300-350 international). This equates to high Stage 3 of the IRIS staging system. If your vet thinks your cat's CKD is less advanced than this, and your cat does not appear dehydrated, then it is probably safer to hold off on sub-Qs for the moment.

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Samus' creatinine is 172 umol/l (normal range 0 - 168), so she's pretty far below this recommendation. Still, it does sound like it might be a good thing to have on hand know where to get quickly....