Angie (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie and this is my co-host and veterinary nurse Extraordinaire Jojo. And today we are talking about senior cats that are losing weight because I see this at least two, maybe three times every week.

JoJo (00:17)
Well, and you know what's funny about this? This always is shocking to me is people be like, Well, they've only lost a pound. A pound of a ten pound cat is a significant

Angie (00:26)
Yeah.

JoJo (00:27)
amount of body weight.

Angie (00:28)
Right. That's like if someone

JoJo (00:30)
Yeah. People think of it just

in pounds and I'm like, Yeah, but think of it in terms of scope.

Angie (00:35)
Yeah, if you weigh 150 pounds, that's like you losing fifteen pounds without trying. And that's usually

JoJo (00:41)
Yeah.

Angie (00:42)
the problem is it's without trying. If someone says, Oh, I've changed my cat's diet and they've lost weight, then that's fine.

my main concern are cats that have not had a change in diet, that are losing weight. They haven't had a change in lifestyle and they're losing weight, which is really common in senior cats.

So there are a lot of reasons why cats lose weight in their senior years. hyperthyroidism is a common one.

Kidney disease can cause weight loss, diabetes can cause weight loss, but so can gastrointestinal disease. And I would say that's probably the most common reason cats lose weight. And so when I have a cat that's lost weight, and sometimes people bring me their kitties because they've lost weight, but sometimes people are bringing me their kitties for their annual exam or for a vaccine, and I'm weighing them.

and I'm like, hey, by the way, did you know your cats lost two pounds?

JoJo (01:40)
Yeah, it's so hard. I just want to give grace for that moment because when you live with another being, you

Angie (01:46)
Yes.

JoJo (01:46)
it's really difficult to see the gradual it's not like they lost a pound in a month typically.

Angie (01:52)
No, it's very slow. Yeah.

JoJo (01:54)
Yeah, so it's slow

and subtle and you just get used to those changes so you're not seeing it, which one of your greatest recommendations, and I know this is not where you were going, is to have a baby scale at home if you have a senior cat and weigh your cat regularly.

Angie (02:08)
Yeah, please do. you will find things more quickly than I can in your cat. It's such an important metric of your senior cat's health. Please get a baby scale. It doesn't have to be expensive. Don't get the ones that are labeled for cats because they're just baby scales with like cat marketing and you're paying for that cat marketing. Don't do that.

JoJo (02:26)
Yeah.

Cat marketing is so expensive. Babies are cheap. Yeah.

Angie (02:31)
Just get the baby scale. Babies are cheap.

Yeah. spend 30 bucks and get that scale and weigh your cat once a month so you can start to see those trends. before I do. Don't wait six months to a year before your vet weighs your kitty again. So I get these kitties that have been losing weight, they have no change in diet.

And the first thing I recommend, I kind of have like this standard decision tree. And the first thing we need to do is run blood work because I need to check for thyroid disease, kidney disease, diabetes, anything else. But those are the kind of the three things I'm looking for in my blood panel. And I would say the majority of the time I don't find anything. But when I find thyroid disease, it is kind of like a slam dunk. So like, that's why. Easy,

JoJo (03:19)
Yeah. Easy.

Angie (03:20)
I can treat that.

We should make a whole episode on that. and then we treat your cat's thyroid disease. Now, sometimes cats with thyroid disease also have intestinal disease, but we'll get to that. And then I can see if your cat has diabetes, which oftentimes that's not the case. And most senior cats have some kidney disease. And what I see a lot of veterinarians do is say, this cat's losing weight and it has kidney disease. That must be the cause of the weight loss. And

JoJo (03:47)
And then they immediately

go protein restriction.

Angie (03:50)
And then they go protein restriction, and meanwhile, there's like an intestinal disease that's left untreated. Your cat has to have very advanced kidney disease for it to be the main cause of weight loss. So if your cat is in stage one or two kidney disease, it is very unlikely to be the sole cause of that much weight loss. And so what we do next is an abdominal ultrasound.

And what we're looking for there is intestinal thickness. And we're looking for the lymph nodes in the abdomen to see if they're enlarged. And then we can kind of get a feel: like, do we think this could be lymphoma or do we think it's most likely inflammatory bowel disease? And sometimes that's difficult to know without an endoscopy. So we get to this point where we've done our blood work. I'd recommend blood work because.

There are some easy things to treat, like the thyroid disease, like the diabetes. And then we have the ultrasound. And then we have to figure out what are we gonna do with these ultrasound results? Most people, even in very affluent areas, don't have the cash to spend $3,000 on an endoscopy. Because what that endoscopy tells us is we can go in there and take some samples and see is this lymphoma?

Or is this inflammatory bowel disease? And I like to have that as a clinician, but I rarely get it. So I just want to let everyone off the hook that if you can't afford an endoscopy for your kitty, it's okay, but they are nice to have. So at that point, we have to decide how are we going to treat this kitty with weight loss? And we think it's intestinal disease, we hope it's not lymphoma.

And what are we gonna do next? So most of the time, if my patients already losing weight, I will start them on steroids, which is a really hard pill, literally, for everyone to swallow. Because no one wants to cat start their cat on steroids.

JoJo (05:55)
No.

Angie (05:56)
it feels awful. And unfortunately a lot of veterinarians will say, We're gonna start your cat on steroids and then we're gonna do it and it's gotta be for life.

And I wish veterinarians would stop saying that because it's scary. It's such a scary thing to say. And so I always tell people we should try steroids. If they don't work, we don't have to continue them. But if they do work, most people want to continue them because their cat feels better.

JoJo (06:21)
do you go to steroids first or do you go to diet change first?

Angie (06:25)
If I have a lot of weight loss, I go to steroids first. Because I don't want my 15 year old cat to get down to six pounds. Because once

they do that, it's just harder for them to put weight back on. Now, if they're a 12 pound cat and we've gotten to this place because they have vomiting and diarrhea, but they haven't lost any weight, then I absolutely try a diet change first.

But if we're to the point where we're just dropping weight all the time, I really feel like stir it. Yes. Yes.

JoJo (06:54)
Right, because a lot of that weight loss is muscle wasting. And that

is really concerning for a senior cat.

Angie (07:01)
Yeah, and they're not absorbing their food. And so I need to fix that. And oftentimes diet alone isn't going to fix it once it's gotten that bad. and so I'll start steroids. And if it's not that bad, then we we try a diet change, like a novel protein diet or a gastrointestinal diet. And I think this is the part of the decision tree where I disappoint the most people because they're like, I've hired you.

As an integrative veterinarian, and you're saying either let's do a prescription diet or steroids. And I think I'm like the biggest disappointment. I know, like,

JoJo (07:34)
Yeah. Wah wah wah. Yeah. You're not holistic at all. I know you hear it, yeah.

Angie (07:42)
yeah. Like there are some things that Western medicine just does a really excellent job at treating. And severe inflammatory bowel disease is one of them. if your cat's

vomiting all the time and having diarrhea all the time or losing weight, it's okay to do steroids. It's going to help them. The chances

JoJo (08:01)
Yeah.

Angie (08:02)
of this helping is so high and the chance of them getting relief, because you know it's a painful crampy disease, is so high with steroids.

JoJo (08:10)
I know you said that it would be disappointing at that point in the decision tree. I'm just gonna challenge

Angie (08:14)
Yes.

JoJo (08:15)
that. Because I think people get disappointed even earlier because it is so frustrating as a pet parent to be like, Well, it's not this and it's not this and to do all these tests to find out it's not that. And so

Angie (08:25)
Yes. Yes.

JoJo (08:27)
sometimes I think there's a frustration in not getting a diagnosis sooner.

Angie (08:32)
I agree with that. And what I do to combat that is when I am pulling that blood, our radiologist comes every Monday afternoon. I just say, Hey, when you're checking out, I want you to snag an abdominal ultrasound.

JoJo (08:46)
Smart.

Angie (08:47)
Yeah, because, if common things happen commonly, this is not going to be from thyroid disease. It's not going to be from kidney disease. It's not going to be from diabetes. This cat probably has intestinal disease that we need to.

flesh out. And so I I kind of know that's where we're going. I get them all set up. So that way when I call 'em, later that week, I can say, Okay, I'm glad we have the ultrasound on Monday 'cause now we can

JoJo (09:09)
So smart. And

if it's hyperthyroidism, then you can just cancel that appointment on Monday. Totally smart. Huh.

Angie (09:13)
Then we just cancel it. Yeah. Yes. Because

I deal with this situation on such a regular basis. I know. Yeah. People are frustrated with sometimes how long it can take. And so we just move it right along. But then the hard part is how do we do the diet change? What will the kitty eat? And so that gets really tailored to the individual cat in the situation. Like I just

Did this work up with a cat and we found I would say some moderate thickening of the intestines. And at that time we actually decided to do a diet change. And she said, you know what? Since we changed the diet, and he hasn't lost any weight, I'm just gonna stick with this because now he's vomiting way less. But now I have, ruled out all of my other differentials and I think, okay, this cat probably has intestinal disease.

And the fact that we're responding to a diet change alone really helps me think it's inflammatory bowel disease, less likely lymphoma. And so then I can move forward.

JoJo (10:12)
Right. Okay. So if we're talking about the individual at home, they can start by weighing their kitty at home. So you're not so far progressed. So do

Angie (10:19)
Yes. Yes.

JoJo (10:22)
this if your cat is how old or older? When like ten?

Angie (10:27)
Um, yeah. I mean, maybe even eight to just get a baseline. Yeah.

JoJo (10:32)
Yeah. Because cats

aren't always coming in for their annual like I feel like we're getting better at getting cats in for their annual

Angie (10:37)
Yes.

JoJo (10:38)
blood work, but dogs are still better getting dogs

Angie (10:40)
Yeah, dogs. Yeah.

JoJo (10:42)
get themselves in the vet by doing something stupid. That's just what happens. That's

Angie (10:44)
Ha ha ha.

JoJo (10:46)
like more likely the case. But so

Angie (10:49)
Yeah.

JoJo (10:49)
weigh your kitty at home. No shame if you didn't see the weight loss. It happens to the best of us. I mean, you used to ask me about Simba.

You're like, is he how does he look? Because you see him every day and I'd see him once a week. So it's just

Angie (11:02)
Well, after

I had my second baby, I looked down at Simba and I was like, You've lost he lost like five pounds. But I didn't notice,

JoJo (11:08)
Yeah, it's just happens.

Angie (11:10)
yes.

JoJo (11:11)
So when do you want someone, when does a cat parent

Angie (11:14)
Mm.

JoJo (11:14)
want to call their veterinarian? Like how much weight loss? If they're monitoring the weight at home and checking in once a month and their cat's lost what? Half a pound on

Angie (11:22)
Half a pound. Yeah.

JoJo (11:24)
a ten pound cat. Fifteen pound cat, half a pound, period.

Angie (11:26)
I think on any. Yeah.

Have a pound 'cause then I wanna know and now if they can explain it, if they're like, Hey, I switched from a kibble diet to a canned diet, that is gonna cause weight loss.

JoJo (11:38)
Or we got a kitten and now my cat plays all the time.

Angie (11:40)
Yes. And so if something like that has happened and then it kind of plateaued, I'm fine. But I wanna know at that half a pound because then it does allow us to do the diagnostics. We maybe don't need to do the ultrasound right away, but once we rule out the thyroid, kidney, and diabetes, those types of diseases, then we can say, hmm, I wonder if we should make some diet changes. Cause if we haven't lost ten to twenty percent of our body weight, I don't need to panic. We can

JoJo (12:08)
Mm-hmm.

Angie (12:09)
We can just take a beat and figure it out. But if you come to me and your cat's already lost five pounds, like for Simba, when I figured that out, I felt terrible for one. He went straight to an endoscopy. We did not pass go. Like he he got an

JoJo (12:22)
Yeah, you were so convinced it was lymphoma.

Angie (12:24)
yeah, I was like, this cat is he's gonna die. Um,

JoJo (12:26)
Mm-hmm. Uh-huh.

Angie (12:28)
but no, he just had really severe inflammatory bowel disease. And I tried so hard to treat him with raw diets.

And supplements. And I felt like such a failure as an integrative veterinarian that like I couldn't fix it with herbs.

JoJo (12:44)
This cat

would still diarrhea or vomit like under the desk, on the stairs. Right. So people

Angie (12:52)
Yes.

JoJo (12:52)
who are dealing with this at home, this this happens to your veterinarian too.

Angie (12:55)
yeah. Yeah.

And then I started him on steroids. Cause once I figured out he had lost that much weight, I was like, oh and so we started him on steroids and he got better immediately and gained weight back.

JoJo (13:07)
Yeah. So somebody who wants to avoid steroids might be able to avoid it by monitoring their weight and getting them in sooner so you can try the diet change.

Angie (13:17)
Maybe.

I do think though, just to manage expectations, when we are able to manage IBD cats with diet alone, I think often later in their life they're gonna still need steroids. I have no data to support that, other than my own practice experience, that it does kind of get worse over time. And, maybe we can buy a few years of a diet change, but it doesn't always

stick if that makes sense. Like sometimes

JoJo (13:43)
Yeah. Yeah.

Angie (13:44)
we still need the steroids. And cats do so well on steroids.

JoJo (13:48)
I know you mentioned that we should do an episode on hyperthyroidism. I believe we did. It's just so I

Angie (13:54)
we did.

JoJo (13:55)
it's so sad that we don't know because we're eighty-four episodes, eighty-five episodes in. So you've

Angie (14:00)
Yes.

JoJo (14:00)
I forget which things we've talked about with real clients and each other. But I'm

Angie (14:04)
Yes, I know. Yes.

JoJo (14:06)
pretty sure there's an episode about hyperthyroidism cats, and we definitely did one on using steroids in cats. And there's definitely

Angie (14:12)
Yes.

JoJo (14:13)
two episodes.

on I B D and your cat's vomiting not being normal.

Angie (14:17)
Yes. So important. Yeah. And your

JoJo (14:19)
Yeah. And fat cats.

So if your cat's getting too fat, there's also an episode for that.

Angie (14:25)
Yeah, like my own cat that's sitting in my lap right now. Who's just

JoJo (14:28)
Mm-hmm. So we got

we got the ki the skinny cat, the weight loss cat, the fat cat, the hyperthyroid, the I B D cat. Just go back in the database. It's there.

Angie (14:34)
We yeah. We've got them.

Yes, we've got them all. Yeah. And if you want to talk about your kitty, you can book time with me and I will go over your cat's records. I'll see how the blood work's looking and I can help you put together a diagnostic plan or maybe a diet plan.

And so you go to boulderholisticvet.com and you click book a consultation in the upper right hand corner. You can find some time on my calendar and we'll meet via Zoom. we'll get all the records ahead of time and I'll have reviewed those. And it's a recorded Zoom call, so you'll have everything. And then AI makes a fun little transcript for you. And so you can get a tailored plan. And I love talking about cats and I love senior cats even more.

So I wanna talk about your senior cat. And I think it's one area where a lot of veterinarians just say, yeah, senior cats just lose weight. I see it a lot. They're like, yeah, that's just a normal. And I

JoJo (15:36)
That's

disappointing. That's kind of what we do to women. Like, yeah. It's just normal.

Angie (15:40)
It is Yes Yeah,

your weight gain and irritability and all that just right and and cats lose weight.

JoJo (15:46)
Yeah. All that belly fat. Hmm. Nothing to do for you. When there's a whole

slew of things we can do.

Angie (15:55)
Right. And that's the same for your cat. just because your cat has kidney disease doesn't mean that they should be losing weight. I just I want to scream that from the rooftop. It's not the end all be all. Just because your cat has kidney

JoJo (16:09)
I heard you.

Angie (16:10)
disease doesn't mean they should be losing weight. We should always be looking for intestinal disease because some of these cats are painful and they're uncomfortable and we ignore

Their belly pain.

JoJo (16:21)
Thank you for covering that on the senior kitties. I'm excited that like if one senior kitty starts getting weighed, then this episode was worth it.

Angie (16:28)
Yes. Get the baby scale.

JoJo (16:31)
Yeah, do it.

Angie (16:32)
We should link one. Can we link one on Amazon and be like, just do this one?

JoJo (16:36)
we totally can. I We don't make any money on it, just in case people are wondering. Yeah. But I'll link one that

Angie (16:39)
No, we don't have any like Amazon affiliate account.

JoJo (16:42)
that we would use in practice.

Angie (16:44)
Yeah, exactly. Okay. Well, I want to hear from you. Comment, tell me about what you thought about this episode. Tell me about your kitty. If your kitty gets weighed, do you weigh your kitty? And don't tell me you get on the scale and then pick up your cat. Because it just is not sensitive enough. People tell me that all the time.

JoJo (16:58)
how come? It's not it's not well, I don't how

you can't give me any reason to get on a scale. I'd rather spend thirty dollars on a cat scale. So no thank you.

Angie (17:13)
Yeah, yeah, get a cat scale or a baby scale. Okay.

JoJo (17:16)
Yep. Okay. Take care.

Angie (17:18)
Bye.