GA Need Urgent Help with Pancreatitis

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Milo and Phyllus

Milo and Phyllus

Member Since 2016
My cat had hypoglycemic episode with a reading of 31 on Feb. 1. He has not recovered. Although I used Karo to bring him around he quite eating and drinking on his own the following day. The cat is feral and can only be handled by me. His vet and every other vet I have taken him to has been unable to safely handle him. He is almost 14 years old. The vet says he is too feeble to sedate for IV fluids or anything else he needs as it will kill him and though he is weak, the stress of being handled since he is my indoor pet feral would be enough to push him on over the edge. So he sent me home with subcutaneous fluids and a B12 injection; both of which made him feel better and able to walk more steadily. He is going to pee normally, but has not had a BM in days, but vet said not worry about that since he has no solid food in his system.

Today I collected urine for ketone testing and the urine was very orange in color. Negative for ketones. I immediately thought severe kidney infection or kidney failure and took the urine in for analysis. The vet called later and said something related to the bile duct and that there were levels in his urine that indicated "a touch of pancreatitis" at which time he asked me to check the ear flaps, eye whites, and gums to see if they were yellow. Yes, the ears and gums appeared "pale" to me yesterday, but they do actually appear yellow on closer examination. Asking about treatment, he informed me to stay on the plan I'm on now and that is as follows:

Clavamox every 12 hours
600 mL of fluids a day as follows;
Syringe feed every 2 - 4 hours (he recommended Sheba for digestibility)
Syringe water every 2 - 4 hours
Several 60 mL sessions of subcutaneous fluids to compensate for what he doesn't ingest. He is 8 lbs.
This is the only treatment he has recommended and has said his best chance of survival lies in home care where he is not stressed.
I have added probiotics to ease nausea and replace good bacteria (Fortify while I wait for FortiFlora), but nothing was recommended for pain. I will be ordering digestive enzymes tomorrow. He does not seem to be in pain; no meatloafing, no crying, etc... Also since he was removed from insulin until he gets through this, I have also added Blood Sugar Gold (sold by petwellbeing.com) to assist with healthy sugar levels.

I am trying to get him strong enough to take to the university hospital in Athens, GA. I am looking for recommendations and suggestions from anyone with experience in dealing with pancreatitis in diabetic cats. To make matters worse, he also has a stuffy nose.

His blood work in May was normal with the exception of slightly elevated Neutrophils (77), Eosinophils and low Lymphocytes (9)

For more information, please see this thread: http://www.felinediabetes.com/FDMB/threads/swallowing-issue-and-swollen-lymph-nodes.173004/
 
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I have no experience with pancreatitis or liver issues. What concerns me deeply about the treatment is the 600ml of fluids a day for an 8 pound cat. That is a lot of fluid, and could well be dangerous.

Please read the warning signs of over hydration here: http://www.felinecrf.org/symptoms_regulation_body_fluid.htm#fluid_buildup (scroll down to Fluid Retention/Build-Up)

Before you give subq fluids, please do a complete body check, especially the abdomen and down the legs to check if the previous subq fluids have been absorbed. If there is a pocket of fluids or if your cat feels squishy, delay fluids.
 
I hope you get some experienced eyes on this-- I'm also going to tag @Marje and Gracie, who wrote the pancreatitis primer I pointed you to yesterday and who has tons of knowledge about all things feline health. I did a little reading yesterday and found that jaundice can occur with pancreatitis in cats, so that fits, but I'm still worried about little Milo. The no BM for a few days-- I don't know why your vet is so unconcerned, it's not like Milo has been on a liquid diet, as I understand it he's been syringe-fed wet food with water mixed in, so he should be having BMs. Even if there's nothing else going on with that, just constipation alone could cause Milo to feel nausea and not want to eat.

To confirm: Milo has not had any bloodwork done during this period of illness, correct? So the only tests that your vet could have done would be on the urine sample you brought in yesterday?
 
Red & Rover (GA) & "Cat" said:
I have no experience with pancreatitis or liver issues. What concerns me deeply about the treatment is the 600ml of fluids a day for an 8 pound cat. That is a lot of fluid, and could well be dangerous.

Please read the warning signs of over hydration here: http://www.felinecrf.org/symptoms_regulation_body_fluid.htm#fluid_buildup (scroll down to Fluid Retention/Build-Up)

Before you give subq fluids, please do a complete body check, especially the abdomen and down the legs to check if the previous subq fluids have been absorbed. If there is a pocket of fluids or if your cat feels squishy, delay fluids.
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I'm reasonably certain that the vet exaggerates how much fluid to give to make sure I understand the importance of it. I may have forgotten to mention that Milo was very dehydrated. I haven't administered 600 mL by any means, and most definitely will check before administering additional fluid. Thanks for the link. Going to read that now.
 
Nan & Amber said:
I hope you get some experienced eyes on this-- I'm also going to tag @Marje and Gracie, who wrote the pancreatitis primer I pointed you to yesterday and who has tons of knowledge about all things feline health. I did a little reading yesterday and found that jaundice can occur with pancreatitis in cats, so that fits, but I'm still worried about little Milo. The no BM for a few days-- I don't know why your vet is so unconcerned, it's not like Milo has been on a liquid diet, as I understand it he's been syringe-fed wet food with water mixed in, so he should be having BMs. Even if there's nothing else going on with that, just constipation alone could cause Milo to feel nausea and not want to eat.

To confirm: Milo has not had any bloodwork done during this period of illness, correct? So the only tests that your vet could have done would be on the urine sample you brought in yesterday?
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That is correct on the blood work and urine sample. He's making his diagnosis on symptoms during last visit compared to what I verbally tell him is going on with Milo, as well as the results of the fresh urine sample I delivered yesterday. I asked again about the constipation and he said it is of no concern since he is being fed mostly liquidy food. I stopped adding water to his food and used a mixer to smooth it enough to pull up in syringes so his food is more solid now and there were two grape size stool droppings in the litter box this morning. I know that was Milo's because that is what he was doing before he quit eating completely. Thinking of adding pumpkin to his food at least once today???
 
JanetNJ said:
600?????? You will do major damage. I hope that's a typo.
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No, that is not a typo. He said 60 mL per session for a total of 600 mL daily to include the amount he takes in orally. He was severely dehydrated. Is that still too much? He said we have to be aggressive due to how badly dehydrated he was.
 
Omg 600 per day is a crazy dangerous amount. THE MOST I have ever heard of being prescribed is 200. 100-150 is more typical. I would caution you. Too much fluid could cause heart failure.
 
For a dehydrated cat, the formula used to determine the fluid deficit (fluid needed) is this: If an animal is severely dehydrated by 15%, as Milo was, then: Body weight in lb x percent dehydration (as a decimal) x 500 = fluid deficit in ml
For Milo the deficit is 600 mL
The maintenance amount would be 50 to 60 mL daily.
His skin is almost pulling back as it should now, he still has a stuffy nose and his eyes are not weepy. I will weigh weigh him today to see where we stand. He was not in his bed this morning when I checked on him. Took me about five minutes to find him. I left him in the closet where I found him resting with another cat. When I left the room, I turned to see that he was following me. He sat at my feet. He hasn't followed me or sat at my feet in 3 weeks. So he was up and about this morning and actually walked to his old water bowl and took just a few little sips. I am very hopeful now!
 
JanetNJ said:
Omg 600 per day is a crazy dangerous amount. THE MOST I have ever heard of being prescribed is 200. 100-150 is more typical. I would caution you. Too much fluid could cause heart failure.
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He definitely is not getting that much. I He had 180 mL on Monday and 120 yesterday. He got another 60 just after midnight last night, so that will count for today's infusion.
 
Phyllus said:
He definitely is not getting that much. I He had 180 mL on Monday and 120 yesterday. He got another 60 just after midnight last night, so that will count for today's infusion.
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I thought you ment you were giving 600 per day.... 60 a day is fine!
 
Well now I'm freaking out even though Milo doesn't feel squishy or have any other symptoms of over hydration. His skin also still does not snap back the way it should, although we are almost there.
 
JanetNJ said:
I thought you ment you were giving 600 per day.... 60 a day is fine!
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The vet did say 600 mL a day! I thought that was excessive. There's no way I could get that amount into this cat. He has definitely been less than 200 mL per day and I was worried I was failing terribly.
 
Phyllus said:
The vet did say 600 mL a day! I thought that was excessive. There's no way I could get that amount into this cat. He has definitely been less than 200 mL per day and I was worried I was failing terribly.
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Very excessive... Esp considering your cat is small.
 
Is Milo still receiving insulin? What are his bg numbers lately? I don't see any current entries on your spreadsheet.
 
Squalliesmom said:
Is Milo still receiving insulin? What are his bg numbers lately? I don't see any current entries on your spreadsheet.
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The vet took him off the insulin until he is more stable since he seems to worsen while on the Novolin N. I am currently giving him Blood Sugar Gold for healthy pancreas function. It is sold at petwellbeing.com. His levels have been ranging at the 325 to 350 range after food. It is my plan to start monitoring again today since he's more stable and to add his numbers to the SS.
 
His glucose level is off the meter with a HI reading. Checked twice and both time HI. Should I give insulin after feeding? It's time for him to eat.
 
Phyllus said:
The vet took him off the insulin until he is more stable since he seems to worsen while on the Novolin N. I am currently giving him Blood Sugar Gold for healthy pancreas function. It is sold at petwellbeing.com. His levels have been ranging at the 325 to 350 range after food. It is my plan to start monitoring again today since he's more stable and to add his numbers to the SS.
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Have you considered trying one of the gentler, long-lasting insulins? He might do better on one of them. I'm concerned that he could be headed for DKA with infection, little food and no insulin. Have you checked his ketones lately? I would check him every day for safety's sake till he's pulled out of this.
 
Even though he seems to feel worse when on the insulin, should I give it to him anyway? Vet said take him off if he feels worse with it, but am I misreading his symptoms?
 
Squalliesmom said:
Have you considered trying one of the gentler, long-lasting insulins? He might do better on one of them. I'm concerned that he could be headed for DKA with infection, little food and no insulin. Have you checked his ketones lately? I would check him every day for safety's sake till he's pulled out of this.
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Vet won't change the insulin, I check ketones daily, and I feed every 2 to 4 hours.
 
He had a 600 last night which I attributed to the sub-q. I didn't check this morning before feeding. He took 12 mL of Sheba perfect portion 3 hours ago. Is it a good idea to feed and give at least 1u to see how he does?
 
Phyllus said:
His glucose level is off the meter with a HI reading. Checked twice and both time HI. Should I give insulin after feeding? It's time for him to eat.
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How much is he eating? He needs to have enough food in his system to help buffer the glucose drop.
Phyllus said:
Even though he seems to feel worse when on the insulin, should I give it to him anyway? Vet said take him off if he feels worse with it, but am I misreading his symptoms?
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Ask your vet about giving a reduced dose if Milo isn't eating much. I've never had a cat with DKA so I don't have any first-hand knowledge, but I think he could be in a very dangerous situation with no insulin at all. Before you give him any, though, please check with your vet and see what he recommends.
Phyllus said:
Vet won't change the insulin, I check ketones daily, and I feed every 2 to 4 hours.
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Why won't he change insulins? Lots of cats get switched to another insulin if they're not doing well with the one they're currently on.
 
Squalliesmom said:
How much is he eating? He needs to have enough food in his system to help buffer the glucose drop.

Ask your vet about giving a reduced dose if Milo isn't eating much. I've never had a cat with DKA so I don't have any first-hand knowledge, but I think he could be in a very dangerous situation with no insulin at all. Before you give him any, though, please check with your vet and see what he recommends.

Why won't he change insulins? Lots of cats get switched to another insulin if they're not doing well with the one they're currently on.
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He feels the Novolin N is doing exactly what it's supposed to do with his curve. I think he doesn't best at 1.5u since it doesn't end up being a drastic, quick drop. The 3 and 2 that he was on was causing him severe spikes. I'm going to call the vet.
 
First, there is absolutely no way to diagnose pancreatitis from urine. It has to be done by a blood sample and then a test called a specfPL needs to be done by the lab.

If his urine is very gold to orange, it's because he has bilirubin in it which indicates a liver issue and if he is jaundiced, that further confirms a liver issue. I know this because it occurred in my Gracie. We gave her fluids to help flush the bilirubin from her urine but she was also on several liver support supplements and medications. Your vet is not going to be able to properly treat Milo without labs. He can make some speculations, which he has done but Milo needs liver specific treatments. If he has a bile duct issue, they have to determine if there is a blockage (which can make him qquite ill if there is). If there is no blockage, he could get ursodiol which is a bile acid that really helps if there is just inflammation but no blockage from a gallstone.

The clavamox "might" help but I would also ask about milk thistle which will help support the liver. There is a supplement called Denamarin specifically for liver support but it is a tablet that has to be given on an empty stomach. If Milo can be pilled, you can order it online and try it. The one for cats is in the blue box.

You cannot base anything on labs done last May. Labs are just a snapshot in time and can change rapidly. I'm wondering if your vet would consider a mild sedative you could administer orally at home and then take him in for an exam and blood draw.

Please do not give your cat 600 mls of fluid a day. I've been giving fluids many years and you can overhydrate a cat. You could give him 100 mls twice a day and he'd be ok if he doesn't have heart issues.

It's important to get lots of calories in him so I'd stay on top of the syringe feeding. Fortiflora will not help here...it is not really a protbiotic and it has animal digest in it which I would not give to my cats. You are better off to get a human probiotic like Renew Life Ultimate Flora Critical Care. I would give 1/3 capsule twice a day mixed in food. Just be sure you don't give the probiotic at the same time as the antibiotic.

I also had Gracie on ondansetron and cerenia for nausea. They work from different modalities to help keep the nausea at bay.

He needs insulin at these numbers. You do not want to risk him developing diabetic ketoacidosis.

If he were my cat, I would get a second opinion.

Sending many vines and prayers for your sweet boy.
 
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Hugs and vines for Milo. I'm concerned about holding the insulin. By doing so for to long you are risking a more severe condition which would require 24 hr hospital care. If vet doesn't feel comfortable with switching to Lantus or levemir, maybe he would agree to Vetsulin. It's better than novalin. Some kitties do well with it. It's worth a try.
 
Thanks for adding your input, Marje-- your experience and knowledge are invaluable! I'm very worried about Milo, he's shown some encouraging signs with the intensive home care Phyllus has been providing, but I'm worried about some of his symptoms. I think he does need some vet care, somehow... Phyllus, do you think a house call vet might be able to do a blood draw and some simple checks if you were there and Milo were in his home environment? Just trying to think of some options.
 
Marje and Gracie said:
First, there is absolutely no way to diagnose pancreatitis from urine. It has to be done by a blood sample and then a test called a specfPL needs to be done by the lab.

If his urine is very gold to orange, it's because he has bilirubin in it which indicates a liver issue and if he is jaundiced, that further confirms a liver issue. I know this because it occurred in my Gracie. We gave her fluids to help flush the bilirubin from her urine but she was also on several liver support supplements and medications. Your vet is not going to be able to properly treat Milo without labs. He can make some speculations, which he has done but Milo needs liver specific treatments. If he has a bile duct issue, they have to determine if there is a blockage (which can make him qquite ill if there is). If there is no blockage, he could get ursodiol which is a bile acid that really helps if there is just inflammation but no blockage from a gallstone.

The clavamox "might" help but I would also ask about milk thistle which will help support the liver. There is a supplement called Denamarin specifically for liver support but it is a table that has to be given on an empty stomach. If Milo can be pilled, you can order it online and try it. The one for cats is in the blue box.

You cannot base anything on labs done last May. Labs are just a snapshot in time and can change rapidly. I'm wondering if your vet would consider a mild sedative you could administer orally at home and then take him in for an exam and blood draw.

Please do not give your cat 600 mls of fluid a day. I've been giving fluids many years and you can overhydrate a cat. You could give him 100 mls twice a day and he'd be ok if he doesn't have heart issues.

It's important to get lots of calories in him so I'd stay on top of the syringe feeding. Fortiflora will not help here...it is not really a protbiotic and it has animal digest in it which I would not give to my cats. You are better off to get a human probiotic like Renew Life Ultimate Flora Critical Care. I would give 1/3 capsule twice a day mixed in food. Just be sure you don't give the probiotic at the same time as the antibiotic.

I also had Gracie on ondansetron and cerenia for nausea. They work from different modalities to help keep the nausea at bay.

He needs insulin at these numbers. You do not want to risk him developing diabetic ketoacidosis.

If he were my cat, I would get a second opinion.

Sending many vines and prayers for your sweet boy.
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Thank you very much for this information. It is very useful. Since I have already put him on milk thistle myself because I already suspected liver problems I was glad to see someone thinking along the same line as I am. I am giving him aprox. 100 mg once daily (1/10th of a 1000 mg human form Milk Thistle capsule since I had it on hand) I have a product called Life Gold here that can be used in conjunction with milk thistle. It is supposed to detox the liver, but I have not included this in his regimen yet as I was afraid of system over load. It is sold by petwellbeing.com as cancer support, but is good for the liver.

Another of feral was diagnosed as emaciated with a liver tumor and was recommended PTS because the tumor was so large. He was expected to continue to lose weight. He was down to 5 lbs with no teeth in his mouth, so couldn't hunt and was expected to die any time. I took him and sheltered him and started him on milk thistle and the Life Gold. It saved his life literally and the effects was noticed within 1 day. He now weighs 9 pounds and can finally jump again.

I was also skeptical of whether he could properly diagnose pancreatitis from urine sample alone. Since he is a very feral cat in a very weakened state this is why my vet hesitates to sedate him as he is afraid he will kill him. He is adamant that home care is what he needs at this time. However! I will call and see if there is a mild sedative that I can give at home that will allow the time for us to transport, get an examination, and do more blood work. I've really had my wonderings about whether or not this vet really just doesn't want to deal with him. I don't like to think that is possible, but there are those that don't like to work with aggressive cats.

I want a second opinion, but I need him stronger to transport as the stress could also kill him. He is currently holding steady and moving around a lot more today than he has been. He has also taken a few sips of water on his own today. He still has yellow tinged ear flaps, gums, and paw pads. I gave 2u insulin per vet's recommendation since he was so high.
 
Phyllus said:
Thank you very much for this information. It is very useful. Since I have already put him on milk thistle myself because I already suspected liver problems I was glad to see someone thinking along the same line as I am. I am giving him aprox. 100 mg once daily (1/10th of a 1000 mg human form Milk Thistle capsule since I had it on hand) I have a product called Life Gold here that can be used in conjunction with milk thistle. It is supposed to detox the liver, but I have not included this in his regimen yet as I was afraid of system over load. It is sold by petwellbeing.com as cancer support, but is good for the liver.

Another of feral was diagnosed as emaciated with a liver tumor and was recommended PTS because the tumor was so large. He was expected to continue to lose weight. He was down to 5 lbs with no teeth in his mouth, so couldn't hunt and was expected to die any time. I took him and sheltered him and started him on milk thistle and the Life Gold. It saved his life literally and the effects was noticed within 1 day. He now weighs 9 pounds and can finally jump again.

I was also skeptical of whether he could properly diagnose pancreatitis from urine sample alone. Since he is a very feral cat in a very weakened state this is why my vet hesitates to sedate him as he is afraid he will kill him. He is adamant that home care is what he needs at this time. However! I will call and see if there is a mild sedative that I can give at home that will allow the time for us to transport, get an examination, and do more blood work. I've really had my wonderings about whether or not this vet really just doesn't want to deal with him. I don't like to think that is possible, but there are those that don't like to work with aggressive cats.

I want a second opinion, but I need him stronger to transport as the stress could also kill him. He is currently holding steady and moving around a lot more today than he has been. He has also taken a few sips of water on his own today. He still has yellow tinged ear flaps, gums, and paw pads. I gave 2u insulin per vet's recommendation since he was so high.
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Have a message in to the vet inquiring about a mild sedative so I can bring him in for blood work.
 
Nan & Amber said:
Thanks for adding your input, Marje-- your experience and knowledge are invaluable! I'm very worried about Milo, he's shown some encouraging signs with the intensive home care Phyllus has been providing, but I'm worried about some of his symptoms. I think he does need some vet care, somehow... Phyllus, do you think a house call vet might be able to do a blood draw and some simple checks if you were there and Milo were in his home environment? Just trying to think of some options.
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I've put in a question at the vet about whether or not a mild sedative would safely work to bring him in for an exam and blood work.
 
would it be safe to put vaporub on my warm steam humidifier? He keeps waking and talking to me so I know he's hungry but he's having a hard time eating again because of the stuffy nose.
 
I wonder if you could suction the nose with a nasal aspirator made for babies. He might try to kill you though. Lol
 
JanetNJ said:
I wonder if you could suction the nose with a nasal aspirator made for babies. He might try to kill you though. Lol
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He would try to kill me, but I might try anyway. I used cotton swabs to dab a little saline just inside the nostrils and he tried to bite me. LOL
 
Phyllus said:
would it be safe to put vaporub on my warm steam humidifier? He keeps waking and talking to me so I know he's hungry but he's having a hard time eating again because of the stuffy nose.
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I don't know whether or not that would be safe, that's a good question for your vet. In the meantime I'd err on the side of caution and not use it.
 
Phyllus said:
would it be safe to put vaporub on my warm steam humidifier? He keeps waking and talking to me so I know he's hungry but he's having a hard time eating again because of the stuffy nose.
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Nope...do not use Vicks. If you just turn on the shower in your bathroom on hot, close the door, and then take him in and stay with him when it’s nice and steamy in there, that should help. But don’t leave him alone in there.

I really do think he needs to be seen by a vet. Have you ever tried Rescue Remedy for animals (no alcohol) or Feliway to try and calm him in the carrier? A really good vet should know how to deal with a fractious cat. My vet said they get a lot of them in her practice; they aren’t necessarily feral but they’ve not been handled.

Have you ever tried to burrito him in a towel with just his head out? I dealt with feral cats at the cat shelter where I volunteered and it was amazing how much they would calm down if they were tightly burritoed as long as their head was out.
 
Marje and Gracie said:
Nope...do not use Vicks. If you just turn on the shower in your bathroom on hot, close the door, and then take him in and stay with him when it’s nice and steamy in there, that should help. But don’t leave him alone in there.

I really do think he needs to be seen by a vet. Have you ever tried Rescue Remedy for animals (no alcohol) or Feliway to try and calm him in the carrier? A really good vet should know how to deal with a fractious cat. My vet said they get a lot of them in her practice; they aren’t necessarily feral but they’ve not been handled.

Have you ever tried to burrito him in a towel with just his head out? I dealt with feral cats at the cat shelter where I volunteered and it was amazing how much they would calm down if they were tightly burritoed as long as their head was out.
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Vet will see him in the morning for IV fluids and blood work.
 
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