Pancreatitis Questions

My foster cat, Kitty, was diagnosed with pancreatitis yesterday, and I have many questions.

I took her to the local ER Tuesday night because she hadn't eaten all day and I was afraid of DKA. She didn't have ketones, but she was very, very anemic and had a fever (infection). The ER vet gave her fluids and sent us home with a page of scary test results and repeated instructions to take her to an internist for ultrasound because, he said, she was losing blood. Wednesday morning, my vet referred us to a specialty hospital and asked them to admit her through the ER so she wouldn't have to wait for treatment.

The ultrasound revealed "changes" in her intestines and an enlarged lymph node. The internist was positive she had lymphoma, but the lab that analyzed the fluid in her stomach found no signs of cancer. Her PLI test was 19. Is that very high? Can pancreatitis cause "changes" in the intestines?

She was hospitalized on IV fluids until this morning. She also got a plasma transfusion yesterday to help the pancreatitis. She ate sometimes in the hospital and refused food other times. She hasn't eaten since we got home. Should I have asked for a feeding tube? How long should a cat with pancreatitis be hospitalized?

She's on Clavamox for the infection, pepcid, buprenex and mirtazapine. None of these things seem to have helped her at all yet. She got the mirtazapine this morning in the hospital. I gave her the pepcid and buprenex when I got home, around 5 pm. She also getting Norvasc for high blood pressure. I asked the internist if I should give her fluids at home, and he said to wait until her recheck next week.

I'm freaking out. My "ex" paid for her hospital stay... $3,600, and she's no better now than she was when she went there on Wednesday. He'll freak out, too, if I ask him for more money, but should she be hospitalized again. Or can I deal with this at home, maybe with a feeding tube and Fluids?

Poor cat... she's had such a crappy life. She's been in a shelter twice, and now she's in a foster home she doesn't especially like because she despises other cats. Six other cats live here.

I've been a bad bean about her ss and haven't updated it for months. She's on 0.05 units of Lev twice a day. I lowered her dose from 0.75 units last week when she dropped into the 40s. She was going from double digits (60s, 70s) to the high 300s until last week. I thought I'd finally found the perfect dose at 0.05 units because she was in the 100s all last week. At the hospital, they don't shoot if the cat isn't well over 200, so she went into the 400s a couple of times. They gave her insulin this morning, and her preshot test tonight was 273. Not bad, I guess, considering she's been getting insulin on a sort of erratic schedule the last couple of days.

 

if she's not eating she needs to be brought back. i just wouldn't take any chances (thinking of my cleo who died while i was relying on the vet's assurances that eventually the antibiotic would kick in). i'd really trust my gut instinct on that. not eating + infection, and you really risk ketones.

i'm guessing the transfusion was for the anemia, which must have been bad for them to do that. did they say something like 8%?

fluids, pain meds, and pepcid were a big part of pancreatitis treatment for cleo. if her heart is at issue you can't give as much fluid, but personally i'd be giving 75ml fluids twice a day unless the 2nd time you feel her and she doesn't need them (her underarm would probably feel squishy). cleo's attacks were irregular but fluids and pain meds meant a huge difference to her. you might want to find out if bupe works for her. i gather it doesn't work for some cats so you may need to switch pain meds.

 

The internist said the transfusion was for the pancreatitis. She said it "helps a lot." Doesn't seem to have done much for poor Kitty though.

She has nonregenerative anemia. I'm not sure what some of these mean: hct 22%, retics 14220, WBC 13.1, neutrophils 12335, platelets 326.

So should I ask for fluids? I think our local ER would sell me a bag of fluids since they saw her the other night. I wonder why the internist told me to wait.

Her heart's fine. Just her blood pressure is high.

Thanks, Chris.

 

Anything over 3.5 is high for pancreatitis.
I give fluids at home to both mine when needed. Ollie's pretty big so I give 150ml BID but for Shadoe I split hers. Even if you give just 50ml it's very helpful.
For sure pain meds. I have bupe on hand now, but initially, they had to order for me so they gave me tramadol for Ollie.
Aside from the fluids and pain meds, pepcid will help and injectable med for nausea may help.
Eating is pretty important; what have you tried to far? When Shadoe was very sick with pancreatitis, i got her to eat by giving foods I would not normally give, just to get her to eat. I also sprinkled forti flora on top, and still do if she is picky on the eating.

get fluids for sure; you can give those yourself easy. I get finer needles than normally come with the kits. 22ga UTW may drip in slow, but they are not huge harpoons. Both mine prefer the 22ga, but 20 are not that bad. 18 are huge and I had trouble getting them through Ollie's skin; it's like a tire so thick.

I don't know why you were told to wait. Fluids turn my cats into perky cats within hours.

 

Kitty doesn't like forti flora. I've tried the ProPlan she ate in the hospital, her favorite flavors of Fancy Feast, the Friskies pouches with gravy, Wellness Healthy Indulgences because they have gravy, rotisserie chicken and baby food. I'm smearing baby food on her mouth now so she'll lick it off. She's decided she hates me. I think I'm going to see if I can get fluids from the local ER and give her some. The idea of a perky cat sounds really appealing to me.

 

I have said before when Shadoe and Ollie had pancreatitis highs, after their fluids they were like a revived wilted flower.
They looked how I feel after drinking water when feeling parched.
I hope kitty feels better soon.

 

Here's info about pancreatitis: http://www.felinediabetes.com/phorum5/r ... 722,876722 It may have info that will help your cat.

 

There's not much I can add, you're already getting great advice. Tucker's PLI results have come back in the 20s and 30s when he's been at his worse.

I might be inclined to talk to the vet about using Flagyl for the AB as opposed to Clavamox since you have a kitty with a belly ache and Clav can cause more belly aches whereas Flagyl is an AB with anti-inflammatory properties that target the belly, it helps the belly feel better. I'd also add B12 injections. Tucker gets his B12 once per week, simple subq that I give in his scruff since he takes his Lev on his sides. B12 doesn't sting so you can give it straight, the B-complex injections do sting so those should be given with subq fluids.

Subq fluids would also be beneficial as others have mentioned. For Tucker, during a flare we use Subq fluids, Buprenex (sometimes 3X per day depending on intensity of flare), injectible Pepcid and often times Flagyl as his CP flares are usually brought on by his IBD.

I hope your little lady feels better quickly.

 

Thanks so much for all the information. Some of the fluid from her stomach was sent to a different lab to be cultured, and the internist should have the results tomorrow. She might want to change the antibiotic anyway, and I'll ask about the Flagyl. I'll ask about the B12, too. But I could get that from my vet, if the internist doesn't approve. I know my vet would give it to me.

I got fluids from our local ER last night, but I'm sort of scared to give them to her. The ER vet said to be careful to not give too much because of the anemia. She talked with me for a long time (it was 3 a.m., and she didn't have much else to do), and she said she thinks Kitty has lymphoma, even though it didn't show up in the cells that were tested. The internist felt that way, too. I'm feeling very discouraged at the moment and very sad for my poor Kitty.

 

If she won't eat, I would consider a food tube. It can save lives.

 

A feeding tube is on my list of things to ask about. Syringe feeding becomes more unpleasant for both of us with each meal.

 

I just wanted to mention that my civie Conor has had dx of IBD for years, but his is generally quiet and then flares at times. One time in 2006, he had awful diarrhea, mucusy bloody..and I was freaking out..so we did Ultrasound strongly suggested lymphoma. We put him on clavamox and scheduled surgery to do biopsies. Well, almost immediately he felt better, and if we had done a US before the surgery we wouldnt have had to open him up. Hes a strange cat..just the antibiotics helped him a lot. biopsies for lymphoma were negative even tho radiologist and 2 gen vets thought it was probably. Vet said "normal ibd intestines"

Anyway, forward to 2008, and fPLI test.. 36!!! My vet humored me and ran the test and boy was he surprised.
My suspicion is that the pancreatitis and ibd flare off each other. when one flares the other does. I sometimes am not sure which is which but usually if hes off his food, its the pancreatitis.

I relay this all to you because it is possible the pancreatitis is causing the intestinal changes or making more obvious ibd. Some cats get Triaditis.. Pancreatitis, IBD, and Cholangeohepatitis all at once.. so there is relationships in those things.

Sending lots and lots of cyber hugs.

 

She doesn't have any IBD symptoms. But it's good to know the pancreatitis could be causing the intestinal changes. That makes me feel a bit more hopeful.

 

Tucker's IBD doesn't present like some other cats do. He has slow motility. When his CP flares or IBD he gets blocked or constipated. When he's constipated, he doesn't want to eat. IBD does not always mean diahrea and vomit.

 

She had terrible constipation when she first got here. Miirilax, and believe it or not, Adequan helped. Going back over years' worth of medical records, her vet always mentioned her pendulous stomach. The shelter vet did, too. Maybe she does have IBD. Can't stress trigger an IBD flare? Things have been stressful for her lately.