Possible pancreatitis back...she's not eating - help!

[Max99]

Hello! I need help! I took Pepsi to the vets yesterday as she hasn't eaten much over the last few days. She was initially diagnosed with pancreatitis back in October and it looks like it's come back again. She's lost a little bit of weight and she's still not eating much. I have just syringed some watered down pouched food (gastrointestinal mod. calorie that the vet prescribed me the last time) and she has licked a bit more off her spoon (yes, we have a special cat spoon for her - it's got a fork/knife at end of the "handle" ) just now.

I'm worried over night that her blood sugar levels may drop. She's due her insulin in about an hour. The vet has given me a short dose of vetergesic m/dose in syringe form to give her am & pm for the next few days. I do have an appt with the vet for Tuesday in case Pepsi doesn't perk up. I'm worried she may lose her sight due to possible low blood sugar. The vet did test her sugar levels on Friday and was pleased with them. The reading was 7.2.

I do have some gluco-gel, I was wondering whether to give her some of that. I've noticed reading the leaflet that comes with the tubes in the box that it's intended for human use as it says to squeeze the whole tube in the mouth. Now, I'm guessing cats don't need as much - how much do I give her and can I reseal the tube afterwards?

Also, I wondered if anyone had any experience with giving cats ranitidine solution? It's another med the vet gave me on Friday to give to Pepsi 1/2 an hour before eating to help curb sickness. When I gave her it this morning, she absolutely hated it and some saliva dripped from her mouth soon after. I wondered if this was normal?

Thanks for reading this far! I'm just anxious about her and her health! :/.

 

[Kris & Teasel]

I'm worried she may lose her sight due to possible low blood sugar. The vet did test her sugar levels on Friday and was pleased with them. The reading was 7.2.

The simple answer is to test her blood glucose before giving her insulin shot - no food at least 2 hours before this test. You indicate in your signature info that you have a glucose meter. What is her current insulin dose?

I do have some gluco-gel, I was wondering whether to give her some of that.

No insulin if her pre shot BG is too low (below 9 or 10?). If it drops very low after a shot (if it was safe to give one) try feeding a small snack of high carb wet food. Maybe save to gluco-gel fo a very low BG (below 3?).

I don't have experience using ranitidine so I can't help with that.

 

[Max99]

The simple answer is to test her blood glucose before giving her insulin shot - no food at least 2 hours before this test. You indicate in your signature info that you have a glucose meter. What is her current insulin dose?

Her dose is 1.5. Why not give her food before the test? She's now due her shot in about half an hour.

No insulin if her pre shot BG is too low (below 9 or 10?). If it drops very low after a shot (if it was safe to give one) try feeding a small snack of high carb wet food. Maybe save to gluco-gel fo a very low BG (below 3?).

Okay, thanks. Do you mean test her right away after I've given her shot if it's safe, or test her a couple of hours after the shot?

I don't have experience using ranitidine so I can't help with that.

No worries. Thanks for the above.

 

[Kris & Teasel]

You want to test her BG before her shot with no food influence. Food can raise BG by a little or a lot. You want to know that the insulin dose is appropriate for her non-food influenced BG. If her BG is higher because of food you might think the dose is safe but it's actually too high. The sequence we recommend is: 1. test BG (no food at least 2 hours before): 2. feed and wait 20 to 30 minutes (Caninsulin can work fast so you want a meal on board) 3. give insulin dose if the test BG was high enough.

 

[Critter Mom]

Hi Max99,

Ranitidine is only useful for suppressing acid production in the stomach. It has limited benefit as a nausea treatment.

With pancreatitis in the mix Pepsi really needs suitable anti-nausea medication and possibly an appetite stimulant plus pain relief while her pancreatitis is flaring.

Here's a very helpful paper from IDEXX laboratories and also a page from Tanya's Site covering treatment of nausea and inappetence problems:

IDEXX Pancreatitis Treatment Guidelines

Nausea, Vomiting, Inappetence - treatment options

I found both of the above links to be extremely helpful.

I see from your signature that Pepsi's on a lot of meds so you'd need to make sure that your vet is really on the ball and makes a point of looking up any possible drug interactions when prescribing treatments for pancreatitis.

To give appetite a bit of a kick start, ask your vet at your Tuesday consult about whether Pepsi would be OK with a Cerenia (anti-nausea) injection. Also ask about starting a course of B12 injections (this can really help - see IDEXX doc). For ongoing nausea management ondansetron is a great anti-nausea treatment but if your vet chooses to prescribe it ask for GENERIC ondansetron (Bristol Laboratories generic if you can get it - less tendency to constipate the cat) and NOT Zofran as the generic is much, much cheaper (under a tenner for 30 tablets of generic versus about £100 for 30 Zofran). If your vet can't supply the generic version ask for a private prescription and take it to a regular pharmacy; ondansetron is a human drug and therefore widely available.

Assuming that there are safe drug options available for Pepsi, be sure to ask your vet to prescribe an adequate quantity of meds to tide you over the Christmas holiday period. Keeping a pancreatitis kitty eating at least some little bit makes a flare easier to manage compared to trying to get a completely inappetent cat to start eating again. Very small, very frequent meals can help keep nutrients getting into the kitty.

Below is a link to some hints and tips to encourage a cat to eat:

Persuading your cat to eat

Tip #1: if you're not already doing so, try raising Pepsi's food and water dishes - it helps when a nauseated cat doesn't have to dip her head down when eating/drinking.

Tip #2: see if Pepsi will eat food from your hand (again, make sure Pepsi doesn't need to lower her head to eat).

I hope Pepsi feels much better very soon.


Mogs
.

 

[Max99]

Thanks Mogs for this invaluable advice! . Pepsi's on dry food as well (Royal Canin hypoallergenic) and she has eaten a few bits of that out of my hand today. Also, I've used the spoon to help feed her the pouched food. She's eaten a bit more pouched this evening so I think she's starting to feel a little better. .

I was worried about what to do over the Christmas period if her pancreatitis flares up again. Thank you for the advice regarding medication. I'll let you know how Pepsi gets on and how it goes on Tuesday.

 

[Critter Mom]

I'm glad to hear that Pepsi managed to get a little bit of food down. If she'll eat the pouched food then that will help with hydration (another vital part of pancreatitis care - be sure to ask the vet to check Pepsi's hydration levels at the Tuesday check-up). If you mix in a teaspoon or two of water to each of her pouched food meals that would help with hydration, too. If necessary try syringing a little water (sideways across the tongue a little at a time to make sure that Pepsi doesn't aspirate the fluids). Also, try poaching some chicken breast in a generous amount of water. Keep the broth and mix it 50-50 with water; it might tempt Pepsi to drink a little more under her own steam.

Keeping fingers and paws crossed for Pepsi; will look out for an update.

(((Hugs 'n' scritches)))


Mogs
.

 

[Max99]

I'm glad to hear that Pepsi managed to get a little bit of food down. If she'll eat the pouched food then that will help with hydration (another vital part of pancreatitis care - be sure to ask the vet to check Pepsi's hydration levels at the Tuesday check-up). If you mix in a teaspoon or two of water to each of her pouched food meals that would help with hydration, too. If necessary try syringing a little water (sideways across the tongue a little at a time to make sure that Pepsi doesn't aspirate the fluids). Also, try poaching some chicken breast in a generous amount of water. Keep the broth and mix it 50-50 with water; it might tempt Pepsi to drink a little more under her own steam.

Keeping fingers and paws crossed for Pepsi; will look out for an update.

(((Hugs 'n' scritches)))


Mogs
.

Hi Mogs,

I've just got back from the vets. Over the last few days, Pepsi hadn't been eating much but she had eaten a few tiny bits of her dry food from my hand, and also in the night, she's been munching on a bit. I did syringe some pouched food in her mouth as well as some water. She has been drinking some from her bowl as well. The vet weighed her and said Pepsi had maintained her weight, which she was pleased about. :]

The vet said that Pepsi seemed a bit better in herself as well, which is also what I thought. I asked about an appetite stimulant tablet, which the vet gave Pepsi when we were there, and also she's given me enough for over the next 10 days. Pepsi was also given an injection of antibiotics that lasts for 2 weeks, just in case (she found it difficult urinating the other day, although she did manage to go), and also a B12 jab. As soon as I let her out of her carrier, she's been running back and forth to her food bowl! Yay! . (Although she's not interested in the wet food.)

I've also been given more pain relief medication, again just in case. The vet said it can be hard to tell whether a cat in in pain but she doesn't think Pepsi's in as much pain as she was when I took her on Friday. (She was rubbing her chin on my hand when the vet was feeling her stomach on Friday, which wasn't happening today.)

I've been given a big syringe to feed her the pouched food if she doesn't eat. I might just feed it her anyway even with her now munching on her dry food, as she's less constipated after having wet food, plus I don't want to throw another lot of opened food away, like I've kept doing recently! Plus, I've just bought more from the vets now. The vet did mention chicken and white fish today. Last time, Pepsi didn't really eat much chicken when I tried to feed her it though. I might try some white fish, as we never tried that with her. Although, with her running back and forth munching away on her dried food right now, as I type!, I don't know if there's any need.

Thanks again for the advice about the medication! .

 

[Critter Mom]

Glad I could be of some help; Saoirse and myself learned all this stuff the hard way ...

Re assessing whether a cat might be in pain with pancreatitis sometimes they hunch up in a 'tense meatloaf' position, very often after eating something. Also watch out for any unusual behaviours; reduction in sociability and especially hiding behaviour (e.g. lurking under tables, behind sofa, or other less accessible places) can be signals that a kitty is in discomfort. I found it very helpful to record all of my observations of Saoirse (clinical signs and behaviours) as a daily journal in her spreadsheet. It helped so much because it enabled me to learn to 'listen' better to what her body was trying to tell me. I also found the info on the Tanya's Site link above extremely helpful as a learning tool for spotting the signs associated with nausea.

I'm pleased and relieved to hear that Pepsi is eating. It's great that you can syringe feed her if needed.


Mogs
.

 

[Critter Mom]

PS: Be sure to get the full course of weekly B12 jabs; they typically give a kitty a real boost! Texas A&M recommend a 6-week course then another jab 1 month later (and IDEXX recommend similar in their pancreatitis treatment guidelines). Here's a link to the TAMU recommendations:

TAMU - B12 Supplementation

Also, here's a helpful article from IBD Kitties:

The Importance of B12


Mogs
.

 

[Larry and Kitties]

I would purchase a vial of B12 and do the injections yourself. You can use an insulin syringe. A lot less expensive than getting it from the vet. For my cats that need B12 I just give the TAMU dose weekly forever. No real need for an expensive blood test. You can't really overdose since it is water soluble and the body just excreats any excess.

 

[Tracey&Jones (GA)]

My vet gave me the vial and I have been injecting it ever since. He received .25ml once a week for six weeks then once a month after that. Was told you can't OD on it and they just eliminate what they don't need.

Jones' B12 was in the "toilet" according to his dr. It has been fine ever since. He does have IBD though.

I only have it checked with his usually blood-work.

 

[Max99]

Thanks all for the advice about the B12. I'll ask my vet when I next phone up. I need to let her know how Pepsi's getting on, which is okay. She is eating but I dont know if she's eating enough. I am trying to use the big syringe to feed her the wet food but she just pushes it out of her mouth with her tongue. The food is very diluted with water so I think she's getting some small bits. She eats a little of her dry food now and again, throughout the day and night (during the day she prefers to eat it out of my hand). She does also drink water from her bowl.

She seems to be better the day after I give her the appetite stimulant tablet, which I give her every other day. The night before last she couldn't settle and was pacing back and forth from the living room to the kitchen. Luckily, she settled last night. My dad bought some chicken yesterday and he's going to make a broth later on today. We do have some white fish in also. Do you know if turkey is okay to give to Pepsi also? With it being a white meat, I'm guessing so but I'm not 100% sure.

Thanks again everyone.

 

[tiffmaxee]

Turkey is fine. Just no garlic or onion.

 

[Critter Mom]

Sending lots of anti-nausea vibes for Pepsi. It's good that she's drinking under her own steam and getting some food down.

I know how physically and emotionally tough it can be helping one's furbaby through a period of poor appetite. How are you bearing up?




Mogs
.

 

[Max99]

Sending lots of anti-nausea vibes for Pepsi. It's good that she's drinking under her own steam and getting some food down.

I know how physically and emotionally tough it can be helping one's furbaby through a period of poor appetite. How are you bearing up?




Mogs
.

Thanks Mogs,

I've been okay the last couple of days or so. Before that, I was worrying so much I couldn't sleep. Now though, she's just been sick a lot, undigested food, as she was eating. I was just about to give her her medication as well and then go to bed. (It's just gone 11pm here.) I don't know what to do now for the best. I've just taken a blood reading and it's 28.2, which is high for her. I don't quite understand these readings sometimes... When she hasn't eaten much or, as now, just been sick, her reading is high anyway. ???

 

[tiffmaxee]

BG can go up due to illness or stress.

 

[Critter Mom]

When she hasn't eaten much or, as now, just been sick, her reading is high anyway. ???

Even without food going into the body, the liver will still be releasing stored sugars into the bloodstream. As Elise says above, illness or stress can really spike BG levels.

I'm sorry to hear about the sleep deprivation (you hum it, I'll play it) but it's encouraging to hear that things have been gradually getting a bit better over the last few days. Sorry to hear about the vomiting bout tonight. Was it a scarf 'n' barf moment, or is it down to her GI issues?

I hope by the time you read this you'll have had some decent, restorative sleep. It's tough enough dealing with just diabetes in the early days after Dx but juggling that with GI problems makes things a lot trickier. I feel for you. Here's hoping Pepsi's tum will have a better time of things on the morrow.




Mogs
.

 

[Max99]

Thank you Tiffmaxee & Mogs,

It was possibly scarf and barf as she was eating at the time and it was undigested food, but she hadn't eaten as much as she'd thrown up. Also, she's been sick in the night but I don't know if it was right after eating (she had eaten through the night, her crunchy food and some of her wet food, which I'm pleased about) or how much it was as it was cleared up before I got downstairs. She seems alert though and I tested her BG just before her morning shot, and it was 21.0.

 

[rawia]

Hope Pepsi is feeling better now

Since you are talking about panceriatitis i have a question about it.

Can a cat with panceriatitis went into remission or diabetes will come back again everytime it flared!!!

 

[Critter Mom]

Can a cat with panceriatitis went into remission or diabetes will come back again everytime it flared!!!

While it is possible for a pancreatitis kitty to achieve remission, recurrence/worsening of pancreatitis is a common cause of cats falling out of remission.

The attached Roomp-Rand study touches briefly on this subject. They recommend reinstatement of insulin treatment ASAP since this appears to give the cat some chance of achieving a second remission (though it may be harder to get there than first time around).


Mogs
.

 

[Max99]

Hi everyone, Pepsi wasn’t feeling well again and she’d been hiding under a blanket. However, I think it was more that she was just fed up being given medication. She’s now on a tablet form of ranitidine as she was still being sick and throwing up undigested food every so often. Hopefully these tablets will help. The vet has also given me a type of treat that can be moulded around a tablet so it’s easy to give her the tablets now.

The reason she’s being sick isn’t to do with her pancreatitis but she now has stomach inflammation. I looked it up and one of the symptoms is throwing up undigested food. She’s not eating as much as she usually does but she does still eat. She has lost a little bit of weight but the vet said this Tuesday that she’s not that worried about it, as long as she still eats and maintains her weight. Pepsi was also given another B12 jab last Friday. The vet said not to worry about her B12 level unless she stops eating altogether. We’ve got another appt in a month’s time. Pepsi’s now out from under the blanket and sitting in the living room with me as I type.

 

[Critter Mom]

A note on B12; in addition to helping with appetite, it can exert an anti-inflammatory benefit.

I hope that the ranitidine will help Pepsi.


Mogs
.

 

[rawia]

Do you have slippery elm bark powder, it helps with my kitties a lot. Members here recommended SEB for me and it worked.

 

[Max99]

Hi all, an update on Pepsi.

Good news is she hasn’t thrown up recently. Bad news is she’s not eating much again. When I went back to the vets with her almost two weeks ago, I forgot to ask for some more appetite stimulant tablets. :/.

She has eaten a tiny bit today but when I took her BG almost an hour ago, it was 2.8. I opened some GlucoGel® and she had some of that (she really liked the taste of it!). I mixed it with a bit on honey as well, which I know she likes. She also had a bit of her crunchy food and some EasyPill, which is like a treat to wrap around tablets. Also, I still have a couple of sachets of the GI food left (she doesn’t eat the meat so I stopped feeding her it, but she loves the jelly) and gave her a couple of spoons of jelly. I’m going to test her BG again in a bit. She’s hiding under a blanket at the moment, which she was doing all yesterday also. :/.

Edit: Good news, her BG has increased to 7.8!