I see Prednisolone come up a lot in threads around here related to cats with chronic pancreatitis and other issues and I'm wondering if it's something I need to discuss with my vet about getting Sebastian on. For those that haven't been following him, he was in the hospital for a week back in November with his first p'titis diagnosis and since then it's been on and off bouts of vomiting and most recently diarrhea from suspected IBD. We didn't do an ultrasound or any of the more invasive IBD tests but the vet did do a physical exam and said the bowels felt thickened. So at the very least it seems he has inflammation of the bowels and pancreas.
I don't trust my vets as far as I can throw them to be up to speed on all the treatments, so between Sebastian's chronic p'titis flare ups, possible IBD, difficulty in managing his weight, and general up-and-down insulin requirements, should I be requesting he get on Prednisolone?
Hi Justin,
First, was whats called a SNAP fPL done in the office? A subsequent SPEC fPL should have also been sent out to confirm the results of the SNAP fPL done in office. These tests are noninvasive & are one of the essential tools & one of the most specific tools vets have to determine if there is actually pancreatitis. The test has strong specificity for moderate to severe pancreatitis cases. Mild cases tend to have less specificity, but again, its used in combination with other important info like clinical symptoms as well as ultrasound (ultrasound is less accurate as far as knowing specifically that its pancreatitis vs another issue causing the changes seen on ultrasound).
Here is a link for info about the SNAP & SPEC fPL & it also provides some info about pancreatitis:
https://www.idexx.com/files/spec-fpl-treatment-for-feline-pancreatitis.pdf
It is not uncommon for cats to have inflammation of the intestines, pancreas & liver-called Triaditis. Some cats start with inflammation of only one organ & then others become inflamed with time. Not all with have triaditis, but again, its not uncommon.
My cat was diagnosed & treated by a top U vet clinic & after diagnosis was confirmed, he was started on Prednisolone, Cerenia, a pain medication & fluids. Slowly each medication was decreased and discontinued as he improved. Unfortunately, he was never able to be titrated off the prednisolone despite several attempts to do so. Pancreatitis is an extremely painful disease & therefore, I was strongly advised to find the least effective dose where my cat was comfortable & clinically stable vs. continuing to lower the dose & crashing him. There are felines with immune mediated pancreatitis & prednisolone is key to treating them. Pain meds don't manage or stop inflammation & Pred does. There are some current studies currently about to begin to see if using combination immunosuppressive drugs WITH prednisolone are helpful with these cases, but in the meantime, there are limited options for cases of more moderate to severe chronic inflammatory pancreatitis.
If he DOESN"T have it based on the fPL, then a drug like buprenorphine (pain), could be helpful. You may also need Cerenia (anti nausea). You could also mention this as an option to try but it may not work because again, it doesn't treat the inflammation.
If he DOES have pancreatitis & Bupe is not an option or you try it & it doesn't work, do NOT be afraid of prednisolone because it will get things under control more quickly & many times, once the cat is stable, you are able to slowly decrease the dose & get them off of it. For some felines, a small every other day dose works amazingly well if they need it for maintenance.
Chronic inflammation that is not managed WILL make BG difficult to control, just like pain & stress does, so its not uncommon to see the issues when the inflammation is not treated. One of my team even told me that DECREASING my cats pred could actually INCREASE his BG vs lowering it IF it results in an increase in his inflammation. That info was a game changer for me!
My cat continues to be on prednisolone. Taking him off is NOT an option (believe me, we tried multiple times....& pretty much made our cat miserable in the process). It would be nice if it was simple/easy & there was another option for my cats illness, but right now there is not & so I play the hand that is dealt & focus on making sure my cat is not in pain & has quality of life. Unfortunately, the knee jerk reaction is for people to go after the prednisolone when they see DM, but the reality is pancreatitis causes destruction of the organ & thats more than likely the cause of the DM vs the prednisolone. Even IF the prednisolone plays a role or is to blame, its a complication of the disease & you manage it because sometimes there just isn't another option. Its just not black & white. Sometimes you have to manage in the gray area
I hope this helps. Its definitely complicated when the pancreatitis is immune mediated, meaning there isn't one flare thats managed with meds & then its stable for awhile, but it is able to be managed
!
One last note, DIET, is important. Moderate to low fat is key. One thing I've found is many of the high protein, low carb diets are LOADED with fat (& calories)
which will definitely aggravate things. And fiber, although given a bad wrap, is also important. Carbs are not carbs! Finding a food with low to moderate fat & even some good carbs (fiber) is helpful not only with gut health but also with regulating BG
!!
Hope things improve! Hang in there!!
