Pancreatitis with no symptoms?

[Djamila]

A few weeks ago, after months in good regulated numbers, Sam's BG shot up from greens and blues to yellows and pinks. Last week I took him to the vet for a check-up to see if he could figure out what might be happening. His teeth look okay, heart and lungs sound fine, no evidence of pain, joints seem good (no x-ray, just from exam), blood work, urinalysis, and urine culture all came back fine. The only thing that was a little off was that the spec-fPL came back at 6.2 indicating possible pancreatitis. However, he's eating just fine, and not vomiting at all.

Vet says he'd like me to give cerenia for a week or so anyway because even if he isn't nauseated, it has anti-inflammatory effects.

I'm wondering from those of you who know about pancreatitis, what you think about giving the cerenia, the lack of symptoms, and if there other things that can cause that number to be elevated that we might need to consider?

Also, does that seem like enough of a cause for the rapid rise in BG, or should we keep looking for something else?

I've updated his labs in the tab on the spreadsheet. Everything else was in normal ranges still, though there are a few things that have changed since his blood work in August.

 

[Sharon14]

Djamila I don’t know anything about pancreatitis, but wanted to bump you up. Hope you find the answer

 

[Kris & Teasel]

A few weeks ago, after months in good regulated numbers, Sam's BG shot up from greens and blues to yellows and pinks. Last week I took him to the vet for a check-up to see if he could figure out what might be happening. His teeth look okay, heart and lungs sound fine, no evidence of pain, joints seem good (no x-ray, just from exam), blood work, urinalysis, and urine culture all came back fine. The only thing that was a little off was that the spec-fPL came back at 6.2 indicating possible pancreatitis. However, he's eating just fine, and not vomiting at all.

Vet says he'd like me to give cerenia for a week or so anyway because even if he isn't nauseated, it has anti-inflammatory effects.

I'm wondering from those of you who know about pancreatitis, what you think about giving the cerenia, the lack of symptoms, and if there other things that can cause that number to be elevated that we might need to consider?

Also, does that seem like enough of a cause for the rapid rise in BG, or should we keep looking for something else?

I've updated his labs in the tab on the spreadsheet. Everything else was in normal ranges still, though there are a few things that have changed since his blood work in August.

@Marje and Gracie is great at reading labs, Djamila. Let's see if she's available.

 

[Marje and Gracie]

His labs look great except the neutrophils. That tells me he either has some kind of infection or inflammation or they can be elevated due to sudden stress or autoimmune/allergic reactions.

Was the specfPL done with at least a six hour fast? The specfPL can also be elevated if there is any issue with any adjacent organs but his labs don’t indicate that there is anything going on at least with the liver or gallbladder. Are his poos good?

It’s interesting to me that his numbers jumped when you switched to Levemir. I am not sure why you are changing insulins so frequently or why you took him off Lantus when he was doing really well. We don’t recommend insulin hopping and a kitty should be on an insulin at least six months. If it isn’t working after six months, than a change could be considered but he’s been on PZ twice, Lantus, and Levemir since he came out of remission in Feb. He didn’t even really need to be switched to Lantus as he was doing well on PZ. I know you didn’t ask about that but others read condos and it’s an opportunity to educate.

Insofar as giving him cerenia, it does have anti-inflammatory properties and he obviously has some type of infection or inflammation even though his tests aren’t showing it. There is potential he could have a very low grade pancreatitis but one would think you’d see something like just a little finickiness with food or the most common symptom “just ain’t right” but can’t put your finger on it. The only way to know for sure is via an ultrasound.

 

[Djamila]

@Marje and Gracie , Thank you so much!

I know it doesn't look like it, but I agree with you that it's not good to insulin hop. He was doing well on Prozinc, but had been hovering around the same dose range for months, so I was hoping that the switch to Lantus might finally kick him into remission. That maybe the flatter curve I had read about would help get him there. When we switched, his numbers were a tiny bit flatter, but he didn't take to it well. Despite the low dose, he would bite at the injection site, and fight me at shot time. Things he'd never done on Prozinc. And whenever I tried to raise the dose a little (from 0.5 to 0.75), he would be so lethargic and grouchy and "off" that I decided it just wasn't a good match for him, despite the decent numbers. And so we went to Levemir. The rise in numbers actually started the last week or so he was on Lantus. His weekly average went from 100 to 142 (if I remember right - I'd need to recalculate to be sure on those numbers) in the last two weeks. Both low numbers, but a notable rise nonetheless. So the spike when we switched, while dramatic, wasn't completely unexpected. At that point I was really conflicted. Do I stay with Levemir and see if he adjusts? Or go back to Prozinc - an insulin I know works for him, and one that allows for faster dose changes to try to get on top of the rapidly rising numbers?

It was an incredibly difficult decision to make. It felt like there wasn't a good answer at the time. Seeing him hit those reds was just too much and I felt like I shouldn't let it continue. I have no intention of switching again. Lantus didn't agree with him, and while I don't blame the Levemir for the rise, I also don't plan to try it again. In hindsight, I wish we had never left Prozinc.

You said that the neutrophils could be infection/inflammation or sudden stress. He was certainly stressed at the vet that day. More than I've ever seen him. So maybe it was a combination of stress and infection of some sort? The spec-fPL was done after a fast. His poos are very good. Well formed, consistent volume, good color, and arriving regularly. He does walk around and meow for a few minutes before going in and taking care of his business, but he's done that for years.

He actually does have the "just ain't right" symptom. I just didn't know that counted as a symptom! And also I was blaming that on the rise in numbers. Although I suppose it could be the cause of the rise in numbers. Chicken and egg...huh?

I picked up the cerenia this morning, and the vet said to also give him a b12 injection once/week for the next six weeks, so they sent me home with a vial of that. They were in the middle of an emergency though, so the directions were pretty brief. It looks from the bottle like it should not be refrigerated. Does that sound correct? Also, does it matter where I give the injection, or just any of the usual insulin injection places?

For the cerenia, I've seen some people on here say to give it an hour before meal time, and others to give it crushed up in food. Since it's not for nausea in this case, is it okay to give it in his food, or is an empty stomach better? I've also seen people say they give 1/4 tablet, but the vet prescribed 1/2 tablet. Is that okay, or is that too much?

I'm sorry for having so many questions! I really appreciate any and all help with all of this!

 

[Marje and Gracie]

@Marje and Gracie , Thank you so much!

I know it doesn't look like it, but I agree with you that it's not good to insulin hop. He was doing well on Prozinc, but had been hovering around the same dose range for months, so I was hoping that the switch to Lantus might finally kick him into remission. That maybe the flatter curve I had read about would help get him there. When we switched, his numbers were a tiny bit flatter, but he didn't take to it well. Despite the low dose, he would bite at the injection site, and fight me at shot time. Things he'd never done on Prozinc. And whenever I tried to raise the dose a little (from 0.5 to 0.75), he would be so lethargic and grouchy and "off" that I decided it just wasn't a good match for him, despite the decent numbers. And so we went to Levemir. The rise in numbers actually started the last week or so he was on Lantus. His weekly average went from 100 to 142 (if I remember right - I'd need to recalculate to be sure on those numbers) in the last two weeks. Both low numbers, but a notable rise nonetheless. So the spike when we switched, while dramatic, wasn't completely unexpected. At that point I was really conflicted. Do I stay with Levemir and see if he adjusts? Or go back to Prozinc - an insulin I know works for him, and one that allows for faster dose changes to try to get on top of the rapidly rising numbers?

It was an incredibly difficult decision to make. It felt like there wasn't a good answer at the time. Seeing him hit those reds was just too much and I felt like I shouldn't let it continue. I have no intention of switching again. Lantus didn't agree with him, and while I don't blame the Levemir for the rise, I also don't plan to try it again. In hindsight, I wish we had never left Prozinc.

You said that the neutrophils could be infection/inflammation or sudden stress. He was certainly stressed at the vet that day. More than I've ever seen him. So maybe it was a combination of stress and infection of some sort? The spec-fPL was done after a fast. His poos are very good. Well formed, consistent volume, good color, and arriving regularly. He does walk around and meow for a few minutes before going in and taking care of his business, but he's done that for years.

He actually does have the "just ain't right" symptom. I just didn't know that counted as a symptom! And also I was blaming that on the rise in numbers. Although I suppose it could be the cause of the rise in numbers. Chicken and egg...huh?

I picked up the cerenia this morning, and the vet said to also give him a b12 injection once/week for the next six weeks, so they sent me home with a vial of that. They were in the middle of an emergency though, so the directions were pretty brief. It looks from the bottle like it should not be refrigerated. Does that sound correct? Also, does it matter where I give the injection, or just any of the usual insulin injection places?

For the cerenia, I've seen some people on here say to give it an hour before meal time, and others to give it crushed up in food. Since it's not for nausea in this case, is it okay to give it in his food, or is an empty stomach better? I've also seen people say they give 1/4 tablet, but the vet prescribed 1/2 tablet. Is that okay, or is that too much?

I'm sorry for having so many questions! I really appreciate any and all help with all of this!

Absolutely no apologies needed. We are here to help and answer questions.

Thank you for explaining on the insulins....it makes more sense. I understand about the Lantus....it can sting some kitties even at low doses...it did my Gracie from time to time. However, just as a note, that increase from 100 to 142 is still pretty flat and might have been addressed with just a dose tweak, if the Lantus hadn’t bothered him.

Levemir is an excellent insulin but you are correct that it will not pull down higher numbers quickly and each dose has to be given long enough for the depot to adjust. I might have suggested you leave him on levemir and try to use Humulin or Novolin R to get the numbers down a bit as you increased the Levemir per the TR protocol.

Yes....”ain’t quite right” is a symptom of pancreatitis. But you are also correct on the chicken/egg because he certainly isn’t used to these numbers and I’m sure he’s feeling it. I think it would take more than just vet stress over a couple hours to cause the neutrophils to rise like that.

Correct that you don’t refrigerate the B12 but it’s interesting that the vet just gave it without any basis. Usually, it’s given to cats we know have intestinal disorders like IBD or who we also know, through testing, have low cobalamin. Sometimes you see a vet give it to an elderly cat as it can perk up appetite a bit. But it won’t hurt him and he’ll excrete any B12 that his body doesn’t use. And you never know, it might be what he needs. You usually give it subq in the scruff like an insulin shot. As I’m sure you know, give the insulin shot some other place the day you give the B12 so if you use the scruff for the B12 either give it far to the side and do the insulin to the other side or use his side or flank for the insulin.

If one is giving cerenia for nausea, it should be given a least an hour before the meal so it has time to settle the tummy before eating although it doesn’t have to be given on an empty stomach (i.e. if kitty has eaten two hours before, it’s ok to give the cerenia). I’m surprised that a cat would eat it crushed up in food as it has a bit of a bitter taste but you can try it. The recommended dosing by the maker of Cerenia, for cats, orally, is 1 mg/kg. If he weighs 11.4 lbs, that is 5.18 kg so his dose would be 5 mg. The cerenia tabs are 16 mg so 1/4 is 4 mg and 1/2 would be 8 mg. Because he isn’t having any outright symptoms of vomiting, etc, I might try the lower dose first and then double it, if needed. I always err on the side of caution on dosing in a non emergency situation because it seems many vets dose too much right off the bat. However, I totally understand if you want to follow your vet’s advice and there are some cats that need double the standard dosing.

 

[Djamila]

Levemir is an excellent insulin but you are correct that it will not pull down higher numbers quickly and each dose has to be given long enough for the depot to adjust. I might have suggested you leave him on levemir and try to use Humulin or Novolin R to get the numbers down a bit as you increased the Levemir per the TR protocol.

Oh goodness! I hadn't even thought of that! Yes, that would have been better than moving him again. I'll tuck that away and maybe be able to help someone else in the same situation some day.

Correct that you don’t refrigerate the B12 but it’s interesting that the vet just gave it without any basis. Usually, it’s given to cats we know have intestinal disorders like IBD or who we also know, through testing, have low cobalamin. Sometimes you see a vet give it to an elderly cat as it can perk up appetite a bit. But it won’t hurt him and he’ll excrete any B12 that his body doesn’t use. And you never know, it might be what he needs. You usually give it subq in the scruff like an insulin shot. As I’m sure you know, give the insulin shot some other place the day you give the B12 so if you use the scruff for the B12 either give it far to the side and do the insulin to the other side or use his side or flank for the insulin.

I think Sam's history is getting complicated enough that I really need to write one of those "profile" pages and attach to my signature. I think he does have IBS at least, if not IBD. He was getting diarrhea often, and used to need metronidazole. He now takes s. boulardii daily and for the most part that keeps it under control. Now he only gets the runs about once every couple of months, and SEB is usually enough to settle him back down. He did have a bout right before the Levemir switch and it was bad enough that I gave him another round of metronidazole. He started it on 10/7 and took for seven days. He'd been back to normal poops for a few days before the Lev switch.

As for the B12, he's already showing some weakness in his back legs from the high numbers -- missing jumps up on the counter, flopping over sideways halfway down the hall -- so I had mentioned to the vet that I was going to start him on zobaline. After the spec-fPL, the vet called and said to do shots instead since he was concerned about absorption between the pancreatitis and the IBS. My vet is a bit of a minimalist. He tends to try the treatment first, and then do the test later if the treatment doesn't work.

I always err on the side of caution on dosing in a non emergency situation because it seems many vets dose too much right off the bat. However, I totally understand if you want to follow your vet’s advice and there are some cats that need double the standard dosing.

I like my vet, but I've been around here long enough to trust your advice over his any day! Besides, this is the kitty who didn't sleep for 30 hours after his dental/extractions. I'll definitely go with the lower dose! He's a sensitive little soul

Thank you a million times for all of your time and help on this! I really appreciate it!

 

[Marje and Gracie]

As for the B12, he's already showing some weakness in his back legs from the high numbers -- missing jumps up on the counter, flopping over sideways halfway down the hall -- so I had mentioned to the vet that I was going to start him on zobaline. After the spec-fPL, the vet called and said to do shots instead since he was con

I do hate to contradict your vet but he’s incorrect about the B12. There are two forms of B12: methylcobalamin and cyanocobalamin and they do different things. The former is usually given orally and is for things like diabetic neuropathy and helping ward off anemia in CKD cats. The latter is injectable and helps with intestinal absorption issues. If he has IBD, it’s a great choice. But you were correct about the Zobaline and I’d be giving that to him as well if he has neuropathy. It won’t improve with the injectable cyanocobalamin.

Sounds like you are on top of the IBD/soft poo. That’s exactly the way I would treat his symptoms as well.

You’re very welcome!!! Thanks for the trust. And the profiles are really helpful.

 

[Djamila]

Okay, one last question (haha)...so do you think I should give the b12 injections, or skip them and just give the zobaline?