For those with cats on Creon... do you sprinkle?

[ecruteak]

Hi! Sorry for yet another query regarding my cat on Creon... hope others can help eyeball the situation and see if I'm missing anything.

So yeah here we are, still chugging away on the Creon train, one pill (Creon 10000) administered whole (i.e. swallowed) before each meal. He eats a LOT, approximately 80+g of wet food (~80 kcal) + 20+g of air-dried food (~100kcals) per meal, twice a day (sometimes with an added small supper nearer to bedtime). It's a total of approximately 360-400kcals per day, which is probably more than enough for a cat (I think?).

And yet, he's not gaining weight as much as I'd like - to recap, this is a male ragdoll kitty who weighed in around 4.7-5kg before his surgery and subsequent EPI caused by said surgery. Over a year later since the surgery (close to 1.5 years now), he's stuck at 4.4kg. Some days he fluctuates to around 4.5-4.6, some days around 4.3. For some reason he can't seem to gain weight.

What we've tried recently:
- Change of food to a more calorie-dense pate - he lost weight on this because, we suspect, it had guar gum as an ingredient, and that, being a fiber, inhibited the Creon function.
- Change of food to freshly cooked food (using a commercial subscription service) - this has so far gone terribly, he has decreased gut motility likely from his surgery (he lacks a pylorus muscle) and after just a day or two of eating freshly cooked food, he gets constipated and his system just slows down to a sluggish crawl - thus making him super, super inappetent.

So now we're back on his old food but still stuck at this weight. And now I'm wondering if it could be an issue of the Creon not working at the optimal time. So just wanted to check - for those of us with cats on Creon, are you guys sprinkling the Creon on top of wet food and feeding immediately, or are you administering the pills whole? Is it likely that there might be a difference if I tried sprinkling? I had not really wanted to previously given the risk of abrasion, but I really would like him to reach 5kg again once in his lifetime... Or is there something else that I'm missing? One other possibility I've been pondering is whether the lack of a pylorus just means his digestion is going to be crap going forward and if there's not much one can do about it at this point.

Thanks for reading, happy to provide further information upon request.

[jilbert57]

Rag doll kitties are so cute!

There should be no abrasion with the enteric coated spheres if you open up the capsule and sprinkle on the food before serving. Has someone here mentioned it being abrasive?
I would try opening the capsule and see if it helps.

I know with the porcine powders we stir in and incubate there might be.

Are you supplementing B12 daily?

You can try adding a tad ( maybe 1/8 t )cold pressed coconut oil to his meal and see if that helps the weight.

Jill

[ecruteak]

Hi Jill, thanks so much for responding

Nobody on this forum has said that enteric-coated granules could be abrasive, we’ve all along been operating based on the instructions of the vet specialist who first diagnosed River’s EPI. He’s been fairly good about being pilled these days, but yeah, somehow the amount of calories he’s eating per day isn’t translating… but yeah I might try sprinkling for a week or two and see if his daily weigh ins show any upward trend…

We supplement B12 every week, injected subcutaneously. Will look into the coconut oil but we do have to be rather careful — this fella’s also in diabetic remission so in that sense we are somewhat limited in what we can feed him (I have spent way too long browsing pet store online websites mentally eliminating about 99% of the commercial food out there…).

[Chance]

I'm not overly familiar with cats and EPI, and Creon. I can only go by my experience with large breed dogs.

Most of the time, there's very little concern about Creon being "abrasive", or causing sores. But it CAN happen. Much less frequently than with powdered enzymes however. Chance did get one mouth sore from Creon (when I sprinkled). My guess, there was very likely one or two of the "pellets" stuck between his lip and gums long enough for the enteric coating to break down. It doesn't happen often, but it *can* happen.

With both my dogs, I've tried either sprinkling OR giving pills whole. For mine, it's worked equally well both ways. No issues either method (in terms of effectiveness. Just Chance had that one sore). But some people do report better success with one method or the other. Some say sprinkled works better. Others report the opposite. Mine is exactly the same either way. I Most often give pills whole; but it's also a lot easier to pill a dog than a cat! I'd probably find it easier to sprinkle food if I was dealing with a cat. I think I'd need a ton of stitches if I had to attempt to pill my cat every day!

You mentioned constipation when feeding the cooked food. What is the fat content of this food? If it's lower in fats, it's possible that the Creon dose is a little high. Mine don't get as constipated as yours does, but poops become really hard little "balls" if Creon dose is higher than it needs to be. Maybe try giving a little less? It's a pain dividing capsules, but it's not impossible. I've become quite adept at it!

[ecruteak]

I’m not sure what the fat content of the food is, it shouldn’t have been too high because it was just chicken meat and chicken liver. One thing about my cat though, which may affect the variables I suppose, is that he doesn’t have a pylorus muscle anymore as a result of surgery - so one possible hypothesis is that his rate of digestion will just be rather irregular, because instead of the food being digested for a while in the stomach before being sent to the small intestine, it could be that the food is just slowly dripping / leaking from the stomach into the small intestine constantly. So, not sure about whether that affects what’s best for him in terms of Creon dosage method.

I do have a few slightly expired Creon capsules (about Jan 2025 expiry) so I’ve been sprinkling that into his food the last couple of days, along with pilling him. If it’s too much, I’ll cut back — thought if his digestion is all over the place anyway we could see if the additional creon covers more ground in his system so to speak.

Still hopeful to hear from more cat owners

[Olesia711]

So sorry to hear that River is not gaining weight.

With regards to the CREON and sprinkling it on top of food... it then must be served IMMEDIATELY... because you want to avoid the moisture in the food to disolve the enteric coating on the little CREON pellets.. of else this can(1) trigger sores in the mouth (2) may become ineffective and not enough enzymes will reach the digestive system because it will be destroyed by the digestion system pH.

SO.... because of the removed pylorus muscle... i think you might be correct in guessing this may be impacting him easily gaining weight...
It might be because the food is moving thru so fast now that River is not getting all the vitamins and minerals he needs to absorb from the food even with the enzymes. EPI patients ARE deficient in fat soluble vitamins already... BUT...it's not wise to tell someone to go ahead and give your cat or dog extra fat soluble vitamins because fat soluble vitamins accumulate and then if you get too much toxicity can happen... so additional fat soluble vitamins and minerals supplemets should ALWAYS be prescribed and approved by a vet.

NEXT... are you feeding smaller portion meals but more meals throughout the day & night... this might also help. And as with many EPI pets, they simply will forever require more calories than what might be the "standard" recommendation for a pet their weight.

I understand that you have to watch it with the coconut oil....When my EPI dog developed Diabetes, even though they said coconut oil was okay, for my dog, i had to stop giving it once she developed Diabetes or else her blood sugar sky-rocketed. Can you give fish oil?

Maybe look at feeding River kitty foods vs. adult foods, as you want to limit the carb and fat intake and yet increase the protein intake which could help with weight gain.

It sounds like you have done a lot of research already River is lucky to have you as his human care-giver!
Oh.... and even though he is already getting B12... its very possible that his B12 is still low and might need it more often as EPI cats do have a worse issue maintaining their B12 levels vs. EPI dogs... Have you recently re-checked his B12 levels? SInce you are giving B12 shots weekly, i am assuming it is Cyanocobalamin version of B12.... in rare cases, sometimes the Cyanocobalamin doesn't produce the expected results and you need to change the version of B12. If this might be a problem with River, (you would have to re-run the B12 test to see where his levels are at) then you can switch to Hydroxycobalamin B12 (injectible) of Methylcobalamin. Not having enough B12 can interfere with weight gain..... but since you are giving him weekly shots, and some versions of B12 don't work as expected... this is probably only a remote possibility, but i thought i'd mention it anyway.

And last but not least, please know that you are welcome to ask as many questions as you have... and we will try as best we can to answer them if we can.

[ecruteak]

Hi Olesia, thanks so much for your input, really appreciate it

Understand on the risk of the enteric coating dissolving... we tried sprinkling the granules today on his breakfast and we'll see how it goes for a couple days. We decided that if he doesn't seem enthusiastic for a particular meal (he's QUITE VOCAL when he's hungry) we may just pill him the old way for that meal, and only sprinkle when there's a reasonable chance that he'll eat everything fast or at least in one sitting. (I imagine dogs eat their meals a lot faster than cats do!)

Yes, the hypothesis of the food moving too fast is what I'm suspecting as well... though of course without one of those gut motility tests (which I don't want to put him through at this point yet), it's only a working theory. That's also contributed to why I wanted to try sprinkling for a bit, with the idea that if there's Creon spread throughout the food, hopefully even if it's all moving through at a weird pace, at least there's some Creon with each part of it. Would this be a legit reasoning, you think? Or does it not matter since everything gets jiggled up in the stomach anyway? (I'm trying to understand why pilling works better for some animals and sprinkling works better for others...)

Unfortunately for the meals, we are currently only feeding twice a day most days, but on days where, e.g. we go out for dinner, we try to feed him dinner early (maybe around 4-5pm?) and then we squeeze in an additional supper around 9-10pm after we're back. We're both working full-time (standard office hours). There's also a slight problem with the days he gets supper though -- sometimes, when he has supper one night, he's still full by breakfast and then he doesn't want to eat promptly. So it's a tricky balancing act...

(The other possible option I suppose is one of those wet food feeders, but I imagine sprinkling Creon on wet food and leaving it in a feeder would not be great cause of the granules starting to dissolve.)

May I check please, what is the desired effect of the fish oil? Is it a source of natural fats? I can look into this, if it will help, and I'll take a look at the kitten food as well (although, because of his diabetes, it feels like 99% of the foods out there are not suitable for him...). I recently ordered some freeze-dried food with a 4.7:1 calorie to gram ratio, aiming to adjust the proportions of his meals (his wet food is approx 1:1 calories to each gram, the air-dried is approx 5:1, but sometimes I'm not sure how well the Creon works on air-dried food because texture-wise it feels like jerky and I imagine something so hard might need more effort to digest? Not sure about this, grateful for any insights!). He seems to like the freeze-dried stuff a LOT, but oh boy, it's pricey.

(Thankfully we get our Creon from chemistwarehouse, that has been one silver lining in all this.)

Aaaand yupppp you're right in that... troubleshooting and research for this boi has felt almost like a fulltime job in the last... 1.5 years? Haha. He was only just over a year old when he had his surgery (Aug 2023), and he's going to turn 3 years old this May. (In that time we also had a human baby so time and energy can get a bit stretched thin, but we do our best)

Please pardon any delays in follow up / replies btw! We are located in Asia so timezones are quite off.

[Olesia711]

Hi River's human companion

I will try to answer your questions to the best of my knowledge.... which often means, i don't have all the answer

with regards to this: I wanted to try sprinkling for a bit, with the idea that if there's Creon spread throughout the food, hopefully even if it's all moving through at a weird pace, at least there's some Creon with each part of it. Would this be a legit reasoning, you think? Or does it not matter since everything gets jiggled up in the stomach anyway? (I'm trying to understand why pilling works better for some animals and sprinkling works better for others...)

With powdered enzymes..... it sometimes "appears" to work better when the enzymes are spread throughout the food-but exactly why, we are not sure, and not sure if this is even true .... but with enteric coated enzymes... this doesn't appear to be the case, maybe cause we just can't spread it in the food, but rather only sprinkle it on top of moist food so that the pellets have something to stick to.
One guess as to why CREON sprinkled on top of the food sometimes works better is because then the digestive system doesn't have to break down the outer capsule casing first.
ANother guess (and i suspect this is more accurate) is that the CREON capsule is designed to dissolve the outer casing and the coating on the little pellets at such a time in a pH environment of 5 (human pH)... where as a dog's digestive pH level is somewhere around 1. This is the most likely scenario...and I suspect the reason there is a variance as far as which dog does better with CREON sprinkled on top of the food, CREON given whole during the meal, CREON given whole right after the meal all depends on the actual pH level in each individual dog's digestive system which determines when it will activate at the right time. Here is a CREON video that visually explains this (in humans) but it is the same process in dogs: https://www.creonhcp.com/mechanism-of-action. i strongly suspect it is all about an internal timing situation.

Feeding Schedule: it's hard! What i used to do is feed breakfast before work, feed lunch as soon as i got home, and feed dinner about an hour before bedtime. Of course by dividing the 2 meals into 3, this allowed for smaller meals. Do you think if the portions were smaller (but more) that this schedule "might" work... or do you think River still will not want to eat breakfast. Of course i was able to do this because at the time my Izzy (dog) was NOT a diabetic yet... 7 years later she developed Diabetes and thankfully we were past multiple feedings and only doing 2 a day because with her Diabetes, insulin and blood sugar ... i was then only able to feed her twice a day...

Forget the wet feeder... that will not work with CREON

Fish oil i don't think it puts much weight, but does add a few extra calories, and... it is an anti-inflammatory, provides needed Omega 3, helps with coat conditions, etc.... it just might be a good supplement to add with your vets approval and clarification as to how much.

Air-Dried food.... OMG... you are so right... really expensive. I feed my dog 50% Air-Dried and 50% home-made (home-made cuts the cost )but the air-dried food is like the best treat ever in our house... my dog LOVES the air-dried food. SOOOoo because you are correct, and it is difficult to "sprinkle" CREON on air-dried food, unless you moisten it... and then it loses it's crunchy texture... what you can do is include a tsp of canned cat food on top of the air-dried food and then sprinkle the CREON pellets on top of the tsp of canned food (since it's moist and will hold the little pellets) and then River can eat the remaining crunchy air-dried food like he always does.

HOpefully some of this information is helpful.

[ecruteak]

@ Olesia

Regarding the pH issue and when the CREON dissolves, I'd imagine there's no way to easily figure out what the actual pH of my cat's stomach is, right? ^^;; unless if he vomits any bile (as he used to do in the past on random occasions) and I suppose one could stick the pH strip in... but that seems a bit of a faff and doesn't really sound very accurate anyway...

Anyway we're weighing him every night to see if this sprinkling method results in any weight gain at all, and if it doesn't then I suppose we can go back to pilling if it's all the same to him.

Re: feeding schedule - he got supper last night at about 10.30pm, which meant this morning we had to coax him back to his breakfast a couple of times (sprinkling some chicken powder on top which he loves). I realise there's an added stressor if I sprinkle the Creon and he decides halfway during a meal he's distracted by something else in the house (he's clearly not a dog). So if there's no weight gain difference then pilling might be better for my stress levels!

For the record, his breakfast today was -
- 70g of wet food = 70kcals
- 10g of freeze-dried food (moistened with water) = 42kcals
- 20g of air-dried food = 100kcals
= total of ~212kcals (so much for a cat!)
and he got one Creon 10000 pill sprinkled.

For portion size, he's used to a fairly large breakfast and dinner I suppose, but I've deliberately tried to keep suppers smaller (last night's supper was just 10g of freeze-dried food (moistened) for an additional 42kcals) so as not to ruin his breakfast. Still working out the optimal food portion distribution... (actually, it occurs to me that keeping a spreadsheet might be a good idea. Will look into this!)

He pooped literally just 5 minutes before I sat down to write this reply and the colour seems a little darker than his usual rather khaki shade, so I'm hoping that might be a good sign with regard to overall digestion. But he's not very consistent so I wouldn't place too much hope on it until I see more of a pattern...

The freeze-dried food I find is EVEN MORE EXPENSIVE than the air-dried food... but it seems to smell more tantalising to him and it's easier to make into a mushy texture (by mixing with water) for easier digestion... so yes, I've been mixing up all the food and making sure the top layer is moist before sprinkling. Thankfully he's not too fussed about the texture / crunch!

/edit: have uploaded a photo of this troublesome kitty into my avatar so as to put a (very cute) face to the name !

[jilbert57]

He is adorable!

Jill