Confirmed pancreatitis. Treatment options?

It is suspected that my kitty may have pancreatitis but we're awaiting blood test results.

I had a different vet from my usual vet and I did not receive clear answers about possible treatment issues. All I got was an appetite stimulant, "Mirtazapine" and told to hold off the antibiotics for 24hrs. I tried asking for Zantac or Pepcid AC but I got a long speech that he doesn't really need it but if i want to, I can. But of course I never got any dosage information. Oh and how could I forget, his first "treatment" idea was lay off high fat foods, I'm quite sure there is a lot more than that.

I asked my vet about pain killers earlier in the week but she said our options are limited because of Spencer's kidney disease. There was only one opioid option available and I was told it could do more harm than good? Although at the emergency vet, they gave him pain meds, pepcid, and anti-nausea--and he was doing great to me.

A little background on the situation: Spencer is 16 y/o diabetic but currently in remission. BG was 460 on admission and +3 in urine. He was on Lantus for 5 days and no longer needed insulin (please home test your cat! It saved Spencer, seriously!). Fructosamine levels indicated his BG levels are very good currently without insulin. I check his blood sugar about weekly to make sure it's still in check, usually under 100.

Spencer had really bad constipation (last weekend). Straining and vomiting--took him to the emergency vet, they treated him with fluids and enemas. He was feeling great after, eating and energetic right after I took him home. But a day after he stopped eating and when I held him or stroked his belly he flinched in pain. Like a big jump, that made me jump when he did it. I took him in to our regular vet, suggested an ultrasound, sub-q fluids at home (100mL everyday) and antibiotics (my vet thought it could possibly be an infection). Did the ultrasound today: his kidneys are abnormal (known stage II kidney disease--His kidney values are BUN: 30 Creatinine: 1.9) and pancreas abnormal.

He is currently not eating. He seems very lethargic and completely unlike himself. I need suggestions please. Also, does Mirtazapine typically work? If so, when does it start to take effect?

And also, you guys are all wonderful. The support is just amazing, I can't believe it.

Re: Possible pancreatitis? Treatment options?

Below is a post with great info on pancreatitis written by Jojo and Bunny. I'm including the link in case the links within her post do not work here.

I've used mirtazapine with my cat (1/4 pill every 3 days) and she will usually show hunger within a few hours. Also, agree you need to get pain meds, but research to see which are best for your cat.

Here's the post - hope it helps.

Best.
Pam & Layla

http://www.felinediabetes.com/phorum5/r ... 722,876722


chronic pancreatitis (or does my cat have a pepcid deficiency?)
Posted by: jojo and bunny(GA) and Y
Date: December 13, 2007 10:26PM

things are going great. diabetic fluffy is nicely regulated. and then one day...just seems "off". BG numbers are higher. not eating much. maybe vomits later that night. hunched up in the 'meatloaf' position. lethargic. what is going on? you listen to the freely dispensed pepcid advice off board and after a couple of days fluffy seems to snap out of it. pepcid rocks! and recommend it to the next person on board that posts about their diabetic cat being "off".
however a few weeks/months later fluffy goes through the same episode. and again. and again. some of the episodes are worse than others. that last attack was bad and you got scared and fluffy was hauled off to vet for some basic blood work. yet nothing really abnormal on the results. is this just a normal part of being a diabetic cat? does your cat have a basic pepcid deficiency??? no.

it is estimated that AT LEAST 30% of all diabetic cats have what is known as Chronic Pancreatitis (CP). makes sense, the pancreas is the weak link with diabetics, in fact CP could be the causative factor on why fluffy became diabetic in the first place. simply put the pancreas has 2 types of basic functions the production of metabolic hormones (like the one everyone knows about, insulin) and the production of digestive enzymes. with pancreatitis it is the production of those digestive enzymes that is out of whack. when the pancreas 'misfires' and activates those digestive enzymes too early, the pancreas actually starts to digest itself and then the surrounding tissue and nearby organs, and systemic inflammation and toxin production ensues. there is a close link between CP with IBD and Cholangiohepatitis, (all three together collectively known as Triaditis).
so what now?

the best diagnostic test available is the fPLI (feline pancreatic lipase immunoreactivity ) [www.vetmed.wsu.edu] not perfect but far better than the options we had in the recent past.
it is far better to have a diagnosis (always) because then you and your vet can form a plan better than just pepcid. SQ fluids and pain management top the list. CP flare ups ARE painful...look carefully at how your cat is acting, it is not easy to tell when a cat is in pain, they hide it well. it is not just nausea that is keeping fluffy hunkered down under the chair, it is pain.
possible tools your vet might have you use:
~SQ fluids
~ pain meds
~ anti-nausea meds (hey look pepcid falls in this category)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed
~ +/- appetite stimulants if needed (and if liver not involved, some of these are contraindicated with liver issues)
can all be used to help the cat through the flare up. your vet can work up a treatment plan for managing your cat's CP flare up attacks.

the veterinary community is still undecided on the issue of fat content of food and whether or not it is something to be considered in feline CP. it is very much an issue in human or canine CP, however felines are very unique in how they utilize the fats (and protein) in their diets. anecdotally, some owners find that lowering the fat content (to about 35% or less) of their CP diabetic cat's diet even though it means they have to raise the carbs helps. ECID, you would have to experiment on that yourself. just a reminder on the topic of food..as a CP flare up begins cats will eat less in the days leading up to it and often not eat at all when the attack is in full force, know that it does not take many days of reduced calorie intake to make hepatic lipadosis possibly rear its ugly head, especially in a liver already compromised.

cats that are simply diabetic with no other condition going on should not need pepcid ever...if you are reaching for the pepcid again, maybe reach for the phone and call your vet instead and discuss the possibility that your diabetic cat might be one in that 30%.

links for those that wish to read about CP further:

[books.google.com]

[72.14.205.104]




--------------------------------------------------------------------------------
~jojo and bunny(GA) and Y(GA) and SettleDown (formerly known as wilson)

Re: Possible pancreatitis? Treatment options?

I've asked about pain medication options but I've been told there's only a opiod option because my kitty has kidney disease. And even with that, theres a lot of side effects and I haven't been encouraged by my vet. I can tell he is in pain.

Also I try feeding him a lot and he just so angry with me this morning lol. He's meowing at me and walks away. Like that kind of please leave me alone meow. He had the appetite stimulant last night. I opened a can of tuna, he drank the juice, took a few bites then walked away. I gave him a piece of chicken he ate it, tried again then he did a retching sound like he was going to puke. So I gave him pepcid ac a few minutes ago. I hope it works.

He really needs to start eating, he's lost 2lbs since March. 9lbs now.

Re: Possible pancreatitis? Treatment options?

Many here, including myself, have used buprenex for our kitties when needed - pancreatitis flares, post-dental pain control, etc.
http://www.veterinarypartner.com/Conten ... A=2182&S=2

It is a controlled substance and most of the time the vet will dispense the pre-filled syringes for x number of doses.

I hope you consider getting the pain meds from your vet.

Re: Possible pancreatitis? Treatment options?

I was just going to ask if the "one opioid" available is buprenex. Many of us have and do use that for our cats during CP flares.

Also, regarding the lower fat food I do have to agree with your vet as it appears to be a huge factor in aggravating pancreatitis. I understand well that lower fat food is also generally higher carb - with the exception of raw food which many here feed - and that does seem counterintuitive with a diabetic. The theory that many of us operate under however is that if the lower fat/higher carb food causes a return to insulin use it is still better than dealing with pancreatitis and its unfortunate possible effects caused by the cats not eating.

Re: Possible pancreatitis? Treatment options?

Wow guys, the pepcid worked! He's not flinching anymore, maybe the pepcid is helping his pain. I gave him chicken, he ate it, I tried to give him more, he like gagged/puke sound. No vomit but thats why I knew it was time for the pepcid. It worked.

Eat ate some tuna today but not anywhere close to a whole can. He is disinterested in his fancy feast. I syringe-feed him dinner a/d. He hates it, fought me before but after a while he relaxed and took in quite a bit. I do notice a slight change in appetite, nothing major, which is big disappointment for me.

I gave him sub-q, a pouch formed and went to his arm. It's still absorbing (just a little left) and I gave it around 7 hours ago. Maybe I should skip sub-q fluids tomorrow?

I'm going to ask a lot questions about the pain meds although right his pain seems to be getting a bit better. I'm a little confused about "antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)" part. Are these gel-tabs or regular powdered vitamins? How should they be administered? Although I'm giving him b-12 for his neuropathy, what does it mean bowel involved?

I'm a little nervous about leaving him alone tomorrow. I start classes tomorrow for the summer, I'll be out by 6am and probably won't be back until 6PM. I hope he will be okay and EAT! Maybe I'll try to syringe feed him some food before I leave.

Thanks again.

Re: Possible pancreatitis? Treatment options?

Hi,

I don't know enough about pancreatitis to offer advice, but seems like you are getting plenty of good advice on that already. Just wanted to check in on you & Spencer and offer support.

As for keep giving the sub-Qs, that depends on if & how much he is drinking & eating on his own. If he's still not eating & drinking properly, I'd keep him hydrated with the sub-qs. You may want to reduce how much sub-q though. Depending on what type of sub-q he was given - one that is only a saline solution, or one with glucose too? Of course, the glucose one will help give him energy, but because it raises his blood sugar levels may also make him feel less hungry, if you see what I mean. It's all a balance. You are going to have to judge it a bit base on what he is taking in on his own.

My vet said a cat needs to drink about 1.7 oz of water per 2.2 lbs of cat. Sorry if it sounds like a weird number, I live in Europe, we talk milliliters and kilos here, I converted it to US measurements, but it will give you an idea of what he should be drinking on his own in 24 hours. If he is drinking more, that's fine, my Suzie does instinctively to keep her kidneys flushed (though much less now that her diabetes is getting under control).

Good luck, keep us posted!

Maria & Suzie

Re: Possible pancreatitis? Treatment options?

Spencer is on lactated ringers, I gave him 50mL yesterday instead of 100mL because the day before it took quite a bit of time to absorb, I don't want to fluid overload him. He's having good and bad days. Mostly good so far after the appetite stimulant works, no flinching in pain, coming out of hiding when someone comes downstairs, purring, and more bright-eyed. He's even making some bowel movements, no oozing diarrhea anymore. No more rockhard poops.

I have to call tomorrow to find out the results (well to check if it's in already) for PLI but I spoke with my vet about pancreatitis and it was fairly depressing. She says its hard to treat and it can take weeks to get better IF they actually get better. And also that pancreatitis can be "life-threatening" and generally leads to a poor quality of life. Also he'll need IV fluids and if things get really bad a plasma transfusion?

What do you guys think? Is a pancreatitis typically a high risk situation with bad outcomes? I was feeling positive but now, I'm not too sure after hearing this from my vet :sad:

Re: Possible pancreatitis? Treatment options?

And he's really not eating enough. I'm going to try and get "Eukanuba Prescription: Maximum Calorie" (it has 340 calories in a can) for him tomorrow. I don't want anything to happen to his liver. It is high in fat though, I'm not sure what to do. It is so hard to get him to eat enough for the day.

Re: Possible pancreatitis? Treatment options?

Aw, I'm sorry he's not eating too well. Honestly I would try to avoid the high fat food though. I am not suggesting that you feed what I feed Moochie because she still eats dry BUT I will tell you that the reason she eats dry food still is that she has CP and I can't afford to have her flare up any more than she does already soooooo...

Moochie lives on Purina Kitten Chow normally. It's pretty low fat. The trade off, of course, is that it is also pretty high carb. When she goes into a pancreatitis flare the food I feed her is the dreaded Science Diet Sensitive Stomach. It's also pretty low fat and pretty high carb as well as being dry but the key is that she will eat it because she loves it.

Sometimes you just have to do whatever it takes to get them to eat and deal with the repercussions later.

Re: Possible pancreatitis? Treatment options?(ETA)

Now that I got the food thoughts out I re-read a little. Chronic pancreatitis can indeed be difficult to deal with but it doesn't have to have a bad outcome. So many of our cats have it and it is quite possibly the original cause of their diabetes so I guess you could call that a bad outcome but at least it's treatable. The worst case scenario is HL - hepatic lipidosis - because they stop eating because of the pain and nausea from the CP flare. That is the biggest risk and yes, it's treatable too but much more deadly. It's not so likely an outcome if you are prepared and it sounds like you are getting prepared. Those LRS are a real godsend at times like this. Also, I will give Moochie anywhere from 50ml to 100ml daily as long as they absorb too so I think you are doing fine with 50.

Moochie is difficult (read impossible) to pill so I deal with her occasional flares by trying to keep fluids, appetite stimulants(mirtazapine/remerol) for when I absolutely have to pill her, and pain meds in the house. I also deal with the regular "maintenance" by feeding her what I feed her - the dreaded dry food that makes her stay on insulin.

My suggestion is that you keep pushing the fluids to get him re-hydrated and try to get him to eat more - whatever food that entails - to get him through this.



ETA - and your vet is only half right - it can take weeks to get through this but it can also only take days so please try not to be too depressed about this. CP is VERY treatable.

Re: Possible pancreatitis? Treatment options?

cornad said:

I have to call tomorrow to find out the results (well to check if it's in already) for PLI but I spoke with my vet about pancreatitis and it was fairly depressing. She says its hard to treat and it can take weeks to get better IF they actually get better. And also that pancreatitis can be "life-threatening" and generally leads to a poor quality of life. Also he'll need IV fluids and if things get really bad a plasma transfusion?

What do you guys think? Is a pancreatitis typically a high risk situation with bad outcomes? I was feeling positive but now, I'm not too sure after hearing this from my vet :sad:

Click to expand...

I'm speaking only to chronic pancreatitis, not acute pancreatitis, of which we thankfully have no experience with. CP flares are miserable and painful, but with the right supportive care, you can keep kitty comfortable and maybe even shorten the episode. And it's not IF they get better - from our observations on this board, they DO get better, with the right support. The right pain meds and supportive treatment make all the difference. You may wish to share these two papers with your vet: Idexx Lab's Treatment Recommendations for Feline Pancreatitis and Diagnosing and Managing Feline Pancreatitis: A Roundtable Discussion

I asked my vet about pain killers earlier in the week but she said our options are limited because of Spencer's kidney disease. There was only one opioid option available and I was told it could do more harm than good?

Click to expand...

I'm guessing the opioid option is buprenorphine/buprenex. Meowzi has fairly advanced kidney disease (creatinine in high 4s, close to 5) - and I can't speak for your kitty - but I have no qualms about using buprenex when she needs it. To not address pancreatitis pain is unthinkable :sad: See Dr Scherk's paper on Feline Pancreatitis: Underdiagnosed and Overlooked:"Analgesia is of critical importance in the comfort of the patient, but also in the progression of the disease/inflammation through the negative physiological effects of pain. Pain causes disease and prevents healing."

With regard to fat content in foods, and keeping in mind that Every Cat Is Different, the Idexx paper on Treatment Recommendations say "Nutritional experts do not believe that high-fat foods are implicated in causing pancreatitis in cats. However, some internists avoid high-fat diets because they have anecdotally recognized an association." We have not found fat content in foods to make a difference for Meowzi.

I'm a little confused about "antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)" part. Are these gel-tabs or regular powdered vitamins? How should they be administered? Although I'm giving him b-12 for his neuropathy, what does it mean bowel involved?

Click to expand...

We used capsules, opened and mixed in food. W.r.t. b-12, methylcobalamin (methyl-B12) is used for neuropathy. Cobalamin, or B-12, is different. See Cobalamin (Vitamin B12) Supplementation on page 2 of the Idexx Treatment Recommendation paper.

Spencer may not be eating enough if he's in pain. Pain causes nausea, as does dehydration, and it becomes a vicious cycle. I see you're already giving fluids; you may need to address pain if it exists. Also consider assist-feeding: hand-feeding or syringe-feeding.

Hope this helps. I hope he feels better soon.

Doh. I see Susie's posted two replies already while I was typing this. Hope I didn't repeat what she said.

Re: Possible pancreatitis? Treatment options?

WCF and Meowzi said:

Doh. I see Susie's posted two replies already while I was typing this. Hope I didn't repeat what she said.

Click to expand...

No, you did much better :mrgreen:

Re: Possible pancreatitis? Treatment options?

Susie and Moochie said:

WCF and Meowzi said:

Doh. I see Susie's posted two replies already while I was typing this. Hope I didn't repeat what she said.

Click to expand...

No, you did much better :mrgreen:

Click to expand...

LOL. I think this is what's called a team effort? ;-)

Re: Possible pancreatitis? Treatment options?

Has he lost a lot of weight, and is he still losing? Cats are tough and have reserves. If he is eating & drinking a little and something is coming out the other end and it's normal-looking, then those are good signs. Food with too much fat in it can aggrevate the pancreas and liver. I agree with Susie, sometimes you have to do whatever and let them eat whatever to just get through it.

Spencer has fight left in him. Don't let the "doom & gloom" of the vet put you off, you're getting a lot of good advice here from folks with actual experience with pancreatitis.

A month ago my Suzie, age 15, was written off as old & dying. I was miserably force-feeding her. I got a second opinion and she was diagnosed with diabetes. We went on Lantus and last week we went for a check-up and the vet could not believe it was the same cat - gained weight, clean fur, bright eyes. I'm just saying that cats are tough and deserve every chance to prove they have 9 lives.

Hang in there Spencer !!!!

Re: Possible pancreatitis? Treatment options?

I've been syringe feeding him because he literally won't eat a thing. Not a single bite. I think I gave the appeite stimulant incorrectly so it is not working the second time around. I'm waiting the 72hrs to regive.

It has been going okay although he completely loathes it. I usually give him pepcid before syringe feeding but I forgot this morning and he threw up quite a bit.
I'm considering bringing him to the vet tomorrow to get pain medication now instead of when the results come in. I got the milk thistle but I'm not sure how much to give.

Thank you very much for the advice.

Spencer is losing weight and I'm at my wits end. I'm sad and very fustrated. All I want is for him to start eating again. The appeite stimulant worked and he ate quite a bit of tuna but that was on Monday and Tuesday. Then Wednesday a lot of syringe feeding.

Pancreatitis/treatment options? Update: Dx confirmed.

Just got back the results. Spencer definitely has pancreatitis. I talked to the vet over the phone.

I asked for pain meds. I am picking up the meds soon. There was talk of overnight hospital stays and "putting an end" to his suffering if he doesn't get better. I feel really down, I really have/had hope pancreatitis is fixable and he can lead a healthy life, now I just don't know what to think.

Re: Possible pancreatitis? Treatment options?

How much are you feeding him over the course of the day?

I hope that once he gets the pain meds, he will be more open to eating on his own. Just remember he doesn't feel well, and even with the appy stim it just might take more time.

I would suggest that you continue to offer food in addition to syringe feeding. Try different brands/types, to see what might make him want to eat.

Re: Pancreatitis/treatment options? Update: Dx confirmed.

cornad said:

Just got back the results. Spencer definitely has pancreatitis. I talked to the vet over the phone.

I asked for pain meds. I am picking up the meds soon. There was talk of overnight hospital stays and "putting an end" to his suffering if he doesn't get better. I feel really down, I really have/had hope pancreatitis is fixable and he can lead a healthy life, now I just don't know what to think.

Click to expand...

please don't be discouraged. it's treatable. many cats on this board have had CP flares. without complications and with the right treatments, they will recover.

it is very hard to evaluate when he doesn't even pain meds on board, and he's been living with this for how long? the last five days? give the pain meds a chance to work. do you know what med you're getting? we use buprenex, and some have used tramadol too. i would not use butorphanol, i don't expect that to be effective.

were your tests done at TAMU or Idexx? if TAMU - ask your vet to talk to their endocrinologists there about treatment options. and share the two papers i linked in an earlier post. we haven't gone the steroid route ourselves, but it was suggested to us by a TAMU endocrinologist - you may want to explore pred if this flare is really that bad.

Re: Possible pancreatitis? Treatment options?

My general instinct is to give everyone as many chances as possible. Gwyn got through two attacks of acute pancreatitis, five strokes, seizures, and two months of paralysis (she walked again), and lived for years with diabetes, severe constipation, megacolon, inflammatory bowel disease, multiple heart problems, CRF and recurrent infections with a suppressed immune system. Over the years, my vet figured she'd die more than once, but she lived to be just over 20.

Spencer's been dealing with this for almost ten days(?) with no pain meds, and it's an incredibly painful disease. Please give the pain meds a chance to work. I know you were scared about the possible side effects of buprenex, but I used it in Gwyn for years with minimal side effects, which was basically that it contributed slightly to her constipation problems.

Continue with the Pepcid and the sub-Q fluids, and (as the mirtz doesn't appear to be working any longer) talk with your vet tonight about the possibility of switching from mirtizipine to cyproheptadine. Continue with the assisted feeding. If Spencer isn't eating the food you're offering, try offering a different food, just keep him eating.

I think reading the papers WCF mentioned earlier is worthwhile, as well as re-reading Jojo's post on CP. And here's my post on pancreatitis from your constipation thread.


It seems to me that your vet isn't being very aggressive in treating this disease. You may need to press him/her to be more responsive and give you what you need to treat Spencer. Or if this is a multiple-vet practice, see if you can see a different vet. Or ask for a recommendation for a vet that can treat this more aggressively -- you're in Brooklyn, right? I *know* we've got folks in Brooklyn who might be able to recommend a vet to help you treat this.

Re: Possible pancreatitis? Treatment options?

I got the buprenex for Spencer, I gave it to him about an hour ago. How long does it take to work? Yeah, I'm considering a second opinion at this point. All I'm getting is, call us if he's not doing better because he'll need to be hospitalized and receive IV fluids and we'll hope he'll start eating. If not, something about a plasma transfusion? It just seems foggy to me.

I've read all the information and articles. And additional googling and my knowledge of pancreatitis (my first patient at clinicals had pancreatitis, which is pretty ironic I guess).

I know it's not an untreatable disease. It's frustrating. I'm completely frustrated and stressed out.

One question on syringe feeding. Typically how much should I feed at a time? 3oz can? 5.5oz can at once is too much, right? How should I space this out? I'm paranoid that he'll vomit again I guess.

I am going to print them out and show her them. He's been fighting this for quite some time now, ATLEAST 10 days. Jeez.

Re: Possible pancreatitis? Treatment options?

ten days, poor kitty :sad: glad you got the buprenex. if you gave the right dose, it should kick in around 45 mins to an hr, i would think. did you give it orally? if oral, it shouldn't be squirted down the throat or swallowed, but squirted into the cheek pouch since it is absorbed through the gums.

how much does he weigh? how much buprenex did the vet say to give, and how often?

syringe-feeding - i think it's an ECID thing. we mix 3 tsps of water with 1 oz of food, and that fits into 2.5 to 3 14 oz syringes. We do two syringes at one time, but we've been syringe-feeding a long time (not because of CP, she has a liver cyst that's pushing against her stomach so she never feels hungry, i.e. no urge to eat). so we do 2/3 oz at one time. but she only eats 2.5 oz a day (senior kitty, sedentary lifestyle, low calorie needs), so it's not hard for us, and both she and we have grown accustomed to the routine. you may need to feed more calories, i don't know. i think he shouldn't get any less than 2/3 his regular daily calorie intake to avoid HL, more is better.

does he seem nauseated? anti-nausea meds could help too, i'd forgotten about that. if pepcid isn't enough, cerenia or zofran are anti-nausea meds we've used - generally cerenia if there's acute vomiting, zofran otherwise, but they both seem effective.

Re: Possible pancreatitis? Treatment options?

Yes I gave it by the gums (The vet tech told me how to do it), it seemed I really had to push for the pain meds. She said it can make cats very lethargic and therefore mask illness progression, she said she only likes to give it at the hospital so he is constantly monitored. I don't know, he does seem kinda sleepy? I don't remember the dosage because it's downstairs. Me and Spence are already in bed and too tired to get it lol. I'm worried a hell of a lot about his liver. He is losing weight and it is very obvious and scary. I gave him a bath and he looked so thin. I almost cried.

It seems to be taking affect, he seems sorta sleepy and no flinching or guarding.

I got the a/d prescription from the vet. My search for those high calorie wet foods fell pretty flat. All I found was iams kitten and fancy feast medley (I forgot the flavor). I mix it with water just enough to make it easy to put into the syringe. I fed him about half the 5.5 oz can already. I think I'll try again around midnight or 1am. I hope one can will be enough.

Re: Possible pancreatitis? Treatment options?

> I got the buprenex for Spencer, I gave it to him about an hour ago. How long does it take to work?

For Gwyn, oral buprenex worked in 30-35 minutes. I never gave her the injectible form, but I assume the timeframe would be similar if it was given sub-Q. If it went IM, it might be longer.

That said, Spencer's been in pain for a very long time. This first dose of buprenex may help dull the pain, but it may not eliminate it completely. When they prescribe pain meds for cancer patients, they try to teach them to take the meds as soon as the pain appears. That's because it's a *lot* easier to keep the pain establishing itself than it is to knock it back once's it's on the ground.

Once Spencer's showing some sign of relief from the pain, you might want to monitor when it appears that it might be coming back. When Gwyn had her second pancreatitis attack, the vet prescribed .25mL of buprenex every 12 hours. However, the pain appeared to return before it was time to give her the next dose. I asked the vet if it was okay to give her half the dose twice as often (.125mL every 6 hours). The vet said it was and Gwyn did much better on that regimen. But every-6-hour dosing can be a little difficult to keep to and many many cats do just fine with every-12-hour dosing. It's just something to keep in mind if the pain meds appear to be wearing off before it's time to give the next dose.


Are you still doing the sub-Q fluids? Those are very important.


> One question on syringe feeding. Typically how much should I feed at a time? 3oz can? 5.5oz can at once is
> too much, right? How should I space this out? I'm paranoid that he'll vomit again I guess.

I've not done syringe feeding for more than a couple of days, so when folks with more experience chime in, please listen to them. As an ideal, I'd use how many ounces (approximately) Spencer used to eat. There are about 30 cc in an ounce. If Spencer used to eat about 5 ounces of food a day, then I'd aim to have him eat about 150 cc per day.

However, when you're sick, you frequently don't feel very hungry, so I wouldn't worry unduly if he has less of an appetite, as long as he keeps eating. I mean, when I've felt sick, I'd get along fine on a piece of toast, a banana and one glass of milk a day. Also, remember that if you've changed his food for the pancreatitis (say, to A/D, which is syringable straight from the can, or adding water to his current food), then his food needs will change as well.

Also, I think you know that when you're syringe feeding, you shoot for the pouch of the cheek and not for the main body of the mouth, right? Aiming for the main mouth makes it a lot easier for them to aspirate the food into their lungs.

I know it's a holiday weekend in the States, so I don't know how much traffic there'll be here. I do know that there's a Yahoo group for Feline Assisted Feeding, which may have some information of use if you don't get a quick enough response here.

Re: Possible pancreatitis? Treatment options?

I too am glad to see that you got the buprenex for Spencer. I hope that he gets some fast relief from this.

One of our members here is a diabetic herself and once wrote a post that I have never forgotten about a pancreatitis attack and the pain. She wrote that the nausea is an immediate and direct result of the level of pain. Kill the pain - stop the nausea. Stop the nausea - stop the anorexia. One day maybe more vets will understand that if humans are in that severe pain from this condition that the animals must be as well.

I will say that Moochie's vet who I dearly love is not a big believer in pain meds for pancreatitis either. I am able to work around that because her vet only makes house calls so there are times when I have to take her to a clinic. I can get buprenex from the clinic if need be and that's what I do.

I am so sorry that this has gone on for so long now and that your vet seems so uncooperative and negative but I am happy to see that the vet finally gave you the pain meds.

Re: Possible pancreatitis? Treatment options?

Oh yeah, definitely on the side of the mouth. I watched a video, the vet tech told me, and most importantly, it's the only way Spencer will let me feed him. I also have him sit up straight to lessen the risk of aspiration. Yes, still doing the sub-q everyday, especially important since he vomited this morning. I try to do it the same time every evening (100mL most times, once I gave him 50mL).

I'm feeling pretty sick myself this week. All I had for the day was a bowl of pasta, I know how Spencer feels. It is completely out of character because he LOVES food. He has been food crazy since my Mom got him from a foster kitty house. He was cuddling with my Mom, it was feeding time and he ran out of her hands so fast and scratched her up! And he has gotten into the Christmas ham, shredded a bag to get to the donuts inside (which was high on the counter). He loves donuts, like completely obsessed. So it is very strange for all of us to see him like this, it tells us how sick he is really feeling.

I was told every 8-12hours. Yes, the pain management is best given to prevent it getting to let's say a 8/10. For people they tell us to offer pain meds before it gets that bad. For my clinicals, I'm constantly asking why patients don't receive pain medications they've requested and there's an order for it. But I think that's a totally different topic, I think. Although it seems like I had to advocate the same way for Spencer.

Well you see, it's hard to know how much Spencer ate throughout the years because we free-fed for YEARS. Up until his diabetes we switched to scheduled feeding. The vet tech suggested 9-11oz a day when he was diagnosed. I tried to give him 3 fancy feast cans a day but it was very hard to get him to eat that much. Even before the pancreatitis.

Re: Possible pancreatitis? Treatment options?

> [The vet] said [buprenex] can make cats very lethargic ...
> I don't know, he does seem kinda sleepy? ...
> It seems to be taking affect, he seems sorta sleepy and no flinching or guarding.

Honestly? I wouldn't worry about the sleepiness at the moment. Spencer's been fighting severe pain for ten days now. He's almost certainly exhausted and just grateful to be able to get some restful, pain-free (or at least less painful) sleep. I'd only worry about the lethargy if it continues.


> it seemed I really had to push for the pain meds.

The buprenex you were given is an opiate. It's a federally-controlled substance, can easily be abused by humans, and the vet has to fill out a bunch of paperwork to prescribe it. And I notice that you weren't given it until you had a formal diagnosis of of pancreatitis through the fPLI test; the test results were probably the point at which the vet decided that it might be okay to give you the buprenex (that you weren't a random drug-seeker trying to get the good stuff by claiming your cat was in pain).

That said, pancreatitis attacks can be incredibly painful, and Spencer's been fighting this for ten days. I honestly wish your vet had given you another option in painkillers in the meantime.


Regardless of whether you continue with this vet, I would try to get copies of the official fPLI test results, as well as copies of his recent history and any other tests they may have run. Keep those in a file; those constitute a formal, official diagnosis of pancreatitis, as well as an official history of Spencer receiving buprenex to treat his pancreatitis attacks. If you ever decide to switch vets temporarily or permanently, or if Spencer has another flare-up on, say, the Friday night of a 3-day weekend and you have to see an emergency vet, you'll have those records to hand to help convince whoever you see that Spencer does indeed have a history of pancreatitis and that a request for painkillers or steroids or whatever should be given due consideration and not rejected out of hand.

That said, with a documented history of pancreatitis and buprenex use, if this or another vet refuses Spencer pain meds for a pancreatitis attack in the future, I'd look for another vet, one who *will* give painkillers.

I hope that you and Spencer have wonderfully quiet weekend together at home --

Jean and her Gwyn


ETA:
>The vet tech suggested 9-11oz a day when he was diagnosed

My Gwyn was usually an 8-9-pounder, and she ate about 5-6 ounces of food per day when she was feeling good, maybe half-to-two-thirds that when she wasn't feeling good. Steroids and appetite stimulants were pretty useful in helping to keep her appetite up.

Re: Possible pancreatitis? Treatment options?

How big is Spencer? I have two civvies in addition to Moochie, my diabetic. The two of them eat only canned food now that they are inside. Bo is a 16 pound Sherman tank and he doesn't always finish the equivalent of 3 FF cans per day although there are days when he wants more. Eartha Kitty is a petite little 8 pounds who probably doesn't finish the equivalent of 2 FF cans per day. Bo is an old dumpster diving former tom that I rescued and Eartha is a feral girl so they know how to eat for sure.

I don't understand the lack of pain management training either. I am not a medical professional but I know that getting ahead of the pain is the key.

Re: Possible pancreatitis? Treatment options?

He is currently 9lbs (on Saturday), probably less now =/. He was originally 11lbs on his diagnosis of diabetes in March.

I'm trying to figure out if one can of a/d will be enough for a day for Spence. He really hates syringe feeding. He makes this annoyed meow. When I let him go, he runs out the room or hides under the bed.

Interesting you mentioned the fear of drug seeking. Huh, I wonder if that's really the reason. If so, I'm pretty upset by that. My cat suffering because of that? Jeez. Disturbing. The emergency vet place was all for giving Spencer all the meds he needed for his constipation. The vet there said if he exhibited any signs of pain, she'll give him pain meds. She bought up the topic, not me. Unfortunately emergency vet prices are extremely inflated and I cannot afford it again.

Re: Possible pancreatitis? Treatment options?

The a/d comes in a 5.5 oz can, right? If it's packed in there pretty solidly it's possibly enough food for the day although I'm not sure about under these circumstances.

BTW, in my experience it's easier to get pain meds for them from the ER vet too - go figure. My ER though won't send more home with me. They give her a shot and tell me to call my vet in the morning.

On a lighter note - hope you get a chuckle at least - I had this incident with the vet clinic I use where I ran out of insulin syringes and couldn't reach Moochie's house call vet for a new Rx. I was going to the clinic to pick up some syringes of B-12 for her anyway so I thought I would call them and ask for a script. They wouldn't give me one. I went to pick up the B-12 and got a lecture from a tech about how they couldn't give me syringes for her since they didn't have a record of her being diabetic. Long story that I won't go into but yes, they did know AND there I stood with TB syringes from them in my hand getting a lecture on why I couldn't have insulin syringes. I guess the drug addicts prefer insulin syringes to TB syringes these days :lol:

Re: Possible pancreatitis? Treatment options?

Hi cornad

I just sent you a PM with the name of one of the only Brooklyn vets I can recommend. Ideally, as I said, you'd get Spencer hospitalized ... Actually, if he's really not eating, it sounds like he may need a feeding tube. It is definitely NOT as scary as it sounds, and it can be a lifesaver. As someone else mentioned. hepatic lipidosis is frequently lethal, and the sad part is that it usually develops secondary to something much more treatable; when a cat gets sick and stops eating for any reason, the primary reason must be treated but also HP must aggressively be prevented.

I agree with Choy Foong about the fat. My late cat had very well documented severe chronic pancreatitis and fat content in food made zero difference. I would go with what your kitty will eat within reasonable limits (cat foods, yes, a stick of butter, no). He just has to eat, it's extremely important.

Re: Possible pancreatitis? Treatment options?

Gosh he's not eating enough . I couldn't give him more canned food by syringe. I don't want him to puke on me. I only managed 3/4 of the 5.5oz can of a/d. I'm so stressed out.

Re: Possible pancreatitis? Treatment options?

cornad said:

Gosh he's not eating enough . I couldn't give him more canned food by syringe. I don't want him to puke on me. I only managed 3/4 of the 5.5oz can of a/d. I'm so stressed out.

Click to expand...

Okay, well, I'm not sure how long it took you to get the 3/4 can into Spencer. I'm *thinking* maybe 7 hours, or am I completely wrong? (I confuse easily.) If so, 3/4 in 7 hours is nothing to sneeze at; like I said, my Gwyn ate roughly one can a day. In any case, he's been ill, his appetite's been down, and he only *just* got on pain meds after a very, *very* long week. I'd leave some food out nearby for him overnight, and let the both of you get some restful sleep tonight. With painkillers and some rest, I'm hoping he'll perk up a bit in the morning.

I'd continue on with the sub-Q fluids, Pepcid and appetite stimulants for now; also steroids if you're on them (I can't remember if you are or not).

Get some sleep, hunh? and give Spencer some warm ear scritches from me --

Jean and her Gwyn

Re: Possible pancreatitis? Treatment options?

The pain meds seem to be working but no interest in eating still. I gave the appetite stimulant but then I realized I might have given it a day early. I called the vet they said most likely he will be okay. I've fed him about 4 oz so far today. He is very upset about feedings. A lot of meowing and running away, jumping around, boy he is fast.

I'm trying to remain positive and hope he'll get better. His spine feels so sharp, I know he's losing a lot of weight. I'm trying my best to feed him.

Re: Possible pancreatitis? Treatment options?

I don't remember: what were you feeding him previously? And I know you said you had no idea how much he generally ate, but do you have any idea how much food you were setting out and how frequently? If you were doing dry food, how frequently did you have to open a new box/bag, and what size did you normally use?

Also, when you said that the vet tech suggested 9-11 ounces of food per day, do you know whether the tech was talking about wet or dry food?

I know that you're very concerned (and rightfully so) about Spencer's weight and appetite. I'm just trying to see if there's some objective way to compare what you're feeding him now with his previous eating level, which would give you some objective basis to see whether and how much you should be concerned.


You said that you managed to get 4 ounces into Spencer today; I'm assuming that 'today' covers that past 12-14 hours or so? Is that correct?

If so, let's start with Dr. Lisa's site, which says "The average cat should eat 4-6 ounces of canned food per day". If Dr Lisa is right, then you got Spencer to eat a (minimal) full day's nutrition in 12-14 hours.

But let's assume your vet tech is right, and Spencer should be eating 9-11 ounces of food every day. Leaving aside that the 9-11 ounces assumes the appetite of a healthy cat, you *still* got 4 ounces of food into Spencer in 12-14 hours. So, in a little more than half a day, you got Spencer to eat a little less than half of what someone suggested might be a full day's worth of food.

If Dr Lisa's suggestions for an average cat are correct, you're over-stuffing Spencer. If the vet tech is right, you *still* managed to get Spencer to eat most of the food they suggested he eat for the period covered. And in either cases, Spencer is still feeling ill and probably doesn't have a full appetite.


I'm most certainly not trying to downplay your concern; I think you're definitely right to be concerned about Spencer's weight loss and appetite, and I know he has quite a ways to go to recover from this attack. But if we can figure out how much Spencer normally ate before all this started, that would give you an ideal amount of food to get him to eat in a day.

Re: Possible pancreatitis? Treatment options?

Dear Cornad, I am very sorry about Spencer's diagnosis of pancreatitis. If you do not feel too overwhelmed you might want to join the Yahoo group for caretakers of felines with pancreatitis. They are very knowledgeable and supportive. If you would like more help with learning how to assist feed him you could also join Feline Assisted Feeding which is another Yahoo group. I belong to that one and I joined originally to learn how to syringe feed an ill cat safely. I hope Spencer is turning the corner with his acute bout. Best regards. Sugarpura

http://pets.groups.yahoo.com/group/Feli ... s_Support/

http://pets.groups.yahoo.com/group/Feli ... d-Feeding/

Re: Possible pancreatitis? Treatment options?

I joined the group, thank you. I'm going to search for a new vet on Tuesday. I feel like the estimate and route of care I was offered for Spence is not enough. Let me show you guys:

1. IV Fluids
2. Famotidine (pepcid)
3. Pain Meds
4. Keflin (antibiotics)
5. SC/CBC

This not very different from what I'm doing at home. I'm doing sub-q, pepcid, pain meds, he was on antibiotics but the other vet told us to stop (didn't see any reaction just diarrhea). And I asked if anyone will be feeding him (that I try to do at home) I was told no, that they don't start feeding right but he goes a long enough time with out eating at the hospital we can consider a feeding tube. So we're going to starve the cat? He's not eating at home, why would he eat there? At least I try to give him quite a bit of food at home.

The only thing he'll eat is whisker lickins (purina). And thats not nearly enough. I got 2-3oz in him so far, I'm going for another 3 before bed.

Re: Possible pancreatitis? Treatment options?

I think Jess sent you a PM for a vet in Brooklyn? I would trust Jess' recommendation; she works at a very good specialty hospital and she knows what qualifies as good care.

Pancreatitis? Treatment options?

Update:

Spencer seems to be doing A LOT better. No more flinching in pain, he ate a can of food this morning/afternoon asked for more food when I came home around 4PM. But I still worry about him eating enough. His ribs and spine feel sharp because he has lost a significant amount of weight with pancreastitis.

Thank you for the support! I'm going to set up Spence with a follow up soon just to make sure he's doing okay. But from what I can see, he is doing a lot better.

Oh, I'm so SO *so* glad you posted -- I've been wondering how things were going! And even I'm happier that Spencer is doing better!

It's wonderful that he's eating and asking for more, and the pain has gone down. I'd suggest keeping him on the Pepcid, etc, for at least a few more days, possibly until his follow-up appointment, depending when that is. You've done a wonderful job with Spencer, honestly.

When you see the vet, please make sure you get a copy of his fPLI test results and his recent chart and test results for your records. As I mentioned earlier, keeping those records handy should make it easier to get Spencer the good drugs (painkillers, steroids, etc) if he has flare-ups in the future.

Not that it's great but it is kind of good because now you know for sure.

Another thing to keep around is a fresh, untapped bag of fluids. Once you've tapped a bag they shouldn't be used for more than a week or two because of bacteria so it's a good idea to keep a fresh bag, admin line, and needles around.

He's lost a considerable amount of weight. Do you think a prescription high calorie diet from the vet might do him so good? I'm still very worried about his liver. He is eating (a can) but it's definitely not enough for the day.

He is so thin, so so thin, it scares all of us, I held him before I got into bed. I know he's feeling better but he's not eating like he should! It's so fustrating. I spent another $20 buying different foods for him to try. He liked the fancy feast medleys but not really the wellness pouches.

Any weight gain suggestions?

Usually people here suggest that you feed anything but the prescription foods BUT my feeling - and I'm sure that of others - is that anything he eats is a plus here. Honestly I think you are doing really well getting him to eat a full can in a day.

Anecdotally only - when Moochie has a flare she can and has lost two pounds or better in a few days' time. I know that comparatively this is not bad but then she has not had attacks that lasted this long either. Once she starts eating again she puts that weight back on pretty fast because the only food she'll eat when coming off a flare is her old Science Diet Sensitive Stomach which is pretty high calorie. This is certainly not a recommended food but she'll eat it and that's what really counts when they are sick

I still think a can of food a day should be sufficient, so it's not something I'd normally be worried about. Also, when you see folks up-thread talking about feeding their cats 2-3 cans a day, remember to take into account the size of the can. I think you'll find that those are generally the 3-ounce cans of food they're feeding, for a total of 6-9 ounces per day.


I think the reaction against prescription foods is mostly because so many vets recommend the stuff so much. And I think that that reaction is fairly pronounced among the folks on this site in particular, as we *know* the high-carb "diabetic speciality" stuff they want us to feed is Bad.

That said, prescription foods do have their place in the world, and you have to make the best decision for your cat that you can. The best food for your cat is one that he will eat, that you can find relatively easily, that fits into your budget, and that's non-aggravating (and preferably beneficial) for whatever health problems your cat has. For diabetics, that usually means a low-carb food -- but I myself and others have knowingly fed higher-carb foods in order to address other, more pressing (or less treatable) health issues. So, yeah, maybe the A/D isn't the best thing in the world to feed, but if Spencer is willing to eat it and nothing else, then eating trumps almost everything.

My primary concern with A/D is that it's probably higher in fat than would be good for a cat prone to pancreatitis attacks. Because of that, I would suggest trying Spencer out on some other cat foods as he gets better.

If you do decide to do a taste-testing with Spencer, may I make a suggestion? When I ran a taste-test on Gwyn, I bought a wide variety of foods and flavors, and rated her reaction to them -- both her initial reaction, as well as after they'd sat out for a few hours. When we finished the trial, I had a list of a number of foods that Gwyn loved, or liked, or was willing to eat, all neatly ranked by her reaction. When making the decision as to what her daily foods would be, while I stocked the supply cupboard with a dozen cans of each of her three favorite flavors, those foods were *not* in her daily rotation.

I did that because I *knew* that, at some point in time, Gwyn was going to lose her appetite and I was going to be sitting there frantically trying to get her to eat *anything* at all. Those three flavors were my secret weapon -- for Gwyn, they were chocolate cake and pizza and ice cream. If I'd fed them to her even semi-regularly, they wouldn't have been nearly as attractive. By with-holding them until she had appetite problems, I had a better chance of getting her interested in eating.

Just something to keep in the back of your mind, in case you ever taste-test Spencer --

Jean and her Gwyn

Both of my FD cats have had pancreatitis.

Shadoe got very sick, very fast and I rushed her into the vet 1/15/10. Here results came back 13.7 and I think the range is 0 - 3.5. She had lost weight as well, but with SQuids, pain meds, and pepcid, she came around nicely and gained back all of her weight and sadly a bit too much more - 11lb up to 14lb! So far, she has had no other attacks. She had all sorts of signs, so there was no mistaking her condition.

Oliver was different. I took him to the vet for his initial checkup/ intro after I adopted him, and his results came back showing mild pancreatitis! Wow, no signs or anything. His result was low, only 3.8, but still present. Since that time, he's had no problem gaining weight and he was very underweight for his size and I could feel every bone in his spine. Now, he's up to 21lb from 15lb, so he too came around when he was ready.

Hopefully you will see the weight come back in due time.

He's definitely eating a lot more now. When I said a can, I meant a 3 oz can which isn't that much. He loves tuna from the can and won't touch his fancy feast anymore. I've been trying ALOT of different brands and I keep in mind what he likes. I'm wondering how I will eventually ease him back into real cat food instead of tuna because he loves it, like really loves it lol :lol: I'm waiting to get his weight up. I think my other kitty (Sam) is getting fatter in the process! Much bigger, he's always had a tiny frame but now we think he's put on weight. It's hard to tell, maybe we just think Sam is getting bigger because Spence has gotten so much smaller and lighter.

We see a big difference in Spence, no more flinching in pain, energy, and no more hiding (he's sleeping right next to me right now as I type this). And he asks for the food we're eating now (a big sign he's getting back to normal, he loves human food). How long should I keep the doing the fluids? He seems to be responding well to 100mL's that I don't really want to stop. His fur doesn't have those terrible flakes anymore. I'm going to check his blood sugar tonight to see if he's still in remission.

Thank you guys for all the support. As his pancreatitis seems to be subsiding, I know I wouldn't have been able to do without all you. The advice and resources are amazing and just great. Thank you so much. :mrgreen:

Hey Cornad --

Okay, the first thing I need to do is apologise. For some reason, I was under the impression you were feeding A/D, which comes in a 5.5oz can. So when you were worried that you could only get Spencer to eat 3/4 of a can, I was thinking, "Hey, that's still over 4 ounces, which isn't bad!" I'd've taken your concern more seriously if I'd realised you were talking about getting him to eat just over 2 ounces. And, yes, I now wish he were eating more food.

Are you using any appetite stimulants? If not and you still have some mirtazapine on hand, you might give that a try again, see if it works better now that he's doing better. If you don't have any mirtz on hand, you might check with your vet if they'll let you try some cyproheptadine; that's the 'other' appetite stimulant, and I kinda prefer it over mirtz. Mirtz lasts longer, which is a plus in a hard-to-pill cat, but it can also make some cats kinda hyper, which isn't a side effect that I'm not always comfortable risking. If pilling is a problem, you can get either one made into a transdermal gel that you gently rub on the inside of Spencer's ears.

Other things folks have used to tempt their cats: baby food (I'm particularly fond of Beechnut's Beef+Beef Broth and Veal+Veal Broth (not Gerber's, though)); deli meats; warming the food just a little; topping with a little parmesan cheese, or bonita flakes or even a little pulverised catnip. Since Spencer's apparently a tuna addict, you might try some of the tuna-mix cat food (chicken+tuna, tuna+salmon, etc), or opening a regular can of tuna and mixing the juice in with some other cat food, then rehydrating the tuna with water (or a little bit of vegetable oil) and feeding him that. Even the human food, as long as it's fairly bland, should be okay. You can also try boiling a chicken breast and see if he's interested in that.


Regarding continuing the fluids: fluids can help with a wide range of things; my main concern would be if Spencer had heart problems, because fluids can stress the heart. So I'd check with the vet about that, but otherwise I don't see a problem continuing until he's back to normal. I *would* suggest keeping track of how long it takes his body to absorb the liquid, and maybe backing off to alternate days or to 50mL a day if needed.

Once you have him on a more normal (not-all-tuna) diet for a at least a couple of weeks, you might want to re-run his kidney panel (BUN, creatinite, USG) and see what the results are. I know that when we switched Gwyn's base food from A/D to Wellness Chicken, the next time we ran her kidney panel it was *significantly* better than it had been. And we saw her kidney function stabilise when we had her on fluids regularly as well. Depending on the results of that future kidney panel, you may want to talk with your vet about keeping Spencer on fluids indefinitely (possibly at a lower dose, possibly not). The test results may also indicate that you should think about a more kidney-friendly diet, or add some potassium supplements. But kidney problems are usually a long-term issue, so focus on getting Spencer to eat a regular diet and gain some weight back first.

One final thing, in case Spencer even does go back on insulin: if he does go back on insulin, please do home BG testing and adjust the dose as needed. We've had cats whose insulin needs would drop after receiving fluids, so the pre-shot tests were even more important in them.

(Eat, Spencer, eat!!!) --

Jean and her Gwyn

Ohh at that time he was eating a/d when I mentioned 3/4 of a can. I've been trying out a lot of foods, sorry for the confusion. But when he ate the entire can on his own, it was of a 3 oz can of fancy feast medleys. He'll eat about 3oz during the day now and over night most of another 3 oz can (unless it's Sam instead.. not sure).

I'm continuing the mirtazapine because he's not at a point where he's eating enough. He hates baby food, doesn't even lick his lips. I've been mixing the tuna with other canned cat food and adding water. I made baked chicken for myself (for some thai food) before I added the curry or anything I tried to give him some, not really interested. My mom made some fish, I have no idea what kind but he went nuts for that. My mom won't let me give him her dinner so lol, a little out of luck. I had to give him just a taste.

I'm on the fence whether or not to return to the same vet for a follow up or just switch to a new one. Either way I have to get a copy of his files.

I barely saw him drink today so I will give fluids today. I guess I will have to wait until I see the vet to know the verdict.

Oops, I thought it was the A/D too in the larger can. Hoping that the mirtazipine helps him eat more for you.

You may already be doing this so ignore me if this is a moot point. Are you adding water to the food? Cats on canned food really do not drink much additional water normally. I do that with my civvies' food. When I open the can I put it under the faucet and then mix it up with a fork. It might help him in another way as well. Sometimes making the food "soupier" makes them eat more when they aren't feeling well.

If you were not happy with the handling of this serious health issue and had to fight to get pain meds, why would you consider a follow up with the same vet? You can get copies of your info from the old vet, then take them to the new vet.
I get copies of all test results for both of my cats, but I would also request copies of the other notes if I were to go to another vet.

What about making an appt with the vet that Jess mentioned to you and then make your decision; your old vet does not need to know that you went to a better vet for a 2nd opinion ;-)
As for requesting copies from the file, just say that you have set up a binder for your cat so that you can keep a formal track of health matter, just in case anything happens to you and someone else needs to take care of him for you.