1/11/25 Raven AMPS 461 (396 Libre) PMPS 397 (411 libre) - Pancreatitis back?

[SophieFRA]

Hi all,

Raven hasn’t been feeling well and has not been eating since Thursday when he threw up for the first time since coming home from the ER, where he was admitted 12/23 for severe pancreatitis. Then it got so bad and his gallblader was obstructed as a side effect and he had to have surgery on 12-27 to place a stent placed to allow bile to flow again. Raven seemed to be recovering well from the surgery and all his bloodwork, which was horrendous (especially bilirubin and kidneys), prior to surgery improved - except for the kidney values (especially creatinine, which was worse for his recheck on Wednesday compared to numbers upon his releaese for 7 days at the ER). When I spoke to Internist Thursday she still thought this could improve - but when she saw him on Wednesday he was also outwardly doing well after and seemed to be recovering.

Since Thursday he seems so much worse. Not eating despite Cerenia, Mirataz, and Gabapentin). He is being tube fed through his e-tube. He is basically just sleeping all day (of course gabapentin has that effect but he has been on gaba for over a week and still had times when he wanted to explore - especially last weekend. I called the internist office and asked about Zofran and they said it could Zofran can actually be “contraindicated in cats and can cause some intestinal blockage so we want to avoid that, especially in Raven's case.”

He has a Freestyle Libre and his numbers have been going steadily up since yesterday evening. Perhaps the shot didn’t “land” well but I was careful about placement as usual. Definitely no furshot.

This morning he was as 396 preshot and food on the libre and 461 on his Relion meter. For the first time there was a huge discrepancy. I crosschecked with Aphatrak at it was 403.

All this suggests to me that he probably has an infection again/his Pancreatitis is back. And I’m terrified there could be more necrosis.

I spoke to his primary vet yesterday (who is wonderful, nuanced and caring, and she shared this fear. She said to bring him in Monday for more bloodwork if he’s still not eating. This was before his blood glucose went up. Still no blood ketones though (0.5 higher than earlier in the week but below 0.6 threshold).

I wish I could share the Libre screenshot, but can’t figure out how to attach anything.

He was at 425 at PM +4 yesterday on libre up from 200 preshot in the morning - steadily climbing throughout the day.

I’m so heartbroken for my little buddy.

https://felinediabetes.com/FDMB/thr...20-pmps-326-libre-vomited-no-appetite.297333/

 

[cecile & bella]

Oh Sophie, I am so sad to read that. I hope he will improve and start eating soon It is so sad.

 

[Staci & Ivy]

Hi Sophie, I’m so sorry to hear Raven isn’t eating. can you try baby food just to get something into him?

I hope you get some advice here on how to handle what’s going on.

I know gabapentin just makes I’ll be sleep whenever I have her on it. Do you think the dose is too high for him?
As far as uploading a picture, you can just try copying and pasting it into the text box. The link button doesn’t work to upload.

And with the Libre, I have found large discrepancies like you have just found between my handheld meter and the Libre. Some people find the numbers are closer some people find them to be further apart, so it just depends. It’s never an exact science and since you double check with the Alpha track it sounds like they’re all somewhat in the range.

Sending you lots of good wishes and healing vines for Raven

 

[Tim & Pookey]

So sorry you’re dealing with the food issue. It sounds like you have a vet who’s on top of things and her care. Good news about ketones as well, hopefully she eats soon

 

[SophieFRA]

Thank you all so much for comiserating and for your advice. It makes such a difference. It‘s so hard to not be able to help him more. His numbers keep climbing up slowly.

Oh wow thanks for the picture sharing advice @Staci & Ivy I thought it‘s just not possible. Here is is latest data.

 

[JoM]

I called the internist office and asked about Zofran and they said it could Zofran can actually be “contraindicated in cats and can cause some intestinal blockage so we want to avoid that, especially in Raven's case.”

I have never heard this before so I went searching and couldnt fine one thing that suggests that Zofran would cause an intestinal blockage. There were things mentioned about not taking antiemetics, until the cat is thoroughly examined, because they can mask the symptoms of an obstruction. I would think Cerenia would be more of a risk in this case than Zofran. Id really like to know where this vet learned this info.
Im so sorry about Raven. Pancreatitis definitely does complicate things.

Edited to add, I did find this VCA page that said Ondansetron is contradicted in cats WITH a GI obstruction, Not that it causes one tho. Ondansetron | VCA Animal Hospitals

 

[SophieFRA]

I have never heard this before so I went searching and couldnt fine one thing that suggests that Zofran would cause an intestinal blockage. There were things mentioned about not taking antiemetics, until the cat is thoroughly examined, because they can mask the symptoms of an obstruction. I would think Cerenia would be more of a risk in this case than Zofran. Id really like to know where this vet learned this info.
Im so sorry about Raven. Pancreatitis definitely does complicate things.

Edited to add, I did find this VCA page that said Ondansetron is contradicted in cats WITH a GI obstruction, Not that it causes one tho. Ondansetron | VCA Animal Hospitals

Thanks for looking into it. I may bring it up with my primary vet on Monday. She‘s been so wonderful, calling me several times a week and is always weighing in with such helpful advice. I‘ve generally felt the internist doesn‘t seem to take my concerns too seriously and it‘s harder when relayed through staff - but maybe that‘s because she knows better. He has a lot of things going on so I think there are a lot of factors to weigh and it‘s not as „straightforward“ to treat as with otherwise healthier cats.

Sometimes, as much as I want to defer to the vets since they‘re the experts, it‘s hard when you know your cat so much better and see things are not working…

 

[Wendy&Neko]

I'm glad Jo popped in about ondansetron (Zofran). I'm on a SCL list where kitties get ondansetron all the time due to getting chlorambucil. We even have an IM vet who pops in occasionally and he's never mentioned any problems with the GI issue kitties there getting ondansetron. My cat who had ileus for a while (slowing of intestines), still got her ondansetron with no problem. Now thankfully off the chlorambucil, but I still used onda for a pancreatitis flair.

He was at 425 at PM +4 yesterday on libre up from 200 preshot in the morning

Could you put some of that mid cycle data in the spreadsheet? It's hard for us to common on anything with just preshot data. I do see a slight uptick on ketones, which has me worried. Though he hasn't been on 2.75 units long enough to say how it's doing. Raven't numbers weren't fantastic last time on 2.75 units and didn't get better until he went to 3.0 units. Pancreatitis will just make the numbers worse. Poor guy, I hate p'titis!

 

[SophieFRA]

I'm glad Jo popped in about ondansetron (Zofran). I'm on a SCL list where kitties get ondansetron all the time due to getting chlorambucil. We even have an IM vet who pops in occasionally and he's never mentioned any problems with the GI issue kitties there getting ondansetron. My cat who had ileus for a while (slowing of intestines), still got her ondansetron with no problem. Now thankfully off the chlorambucil, but I still used onda for a pancreatitis flair.

Could you put some of that mid cycle data in the spreadsheet? It's hard for us to common on anything with just preshot data. I do see a slight uptick on ketones, which has me worried. Though he hasn't been on 2.75 units long enough to say how it's doing. Raven't numbers weren't fantastic last time on 2.75 units and didn't get better until he went to 3.0 units. Pancreatitis will just make the numbers worse. Poor guy, I hate p'titis!

Thanks so much for weighing in. That‘s true about him not doing that well on 2.75u before. Thanks for putting it in perspective. Will try to lobby for a dose increase first thing Monday.

I added some midcycle data from the Libre to the spreadsheet - indicated by L behind number and then manually colored cells. Good tip. It makes it so much easier to process.

I‘m also posting screenshots of the daily graphs below

 

[SophieFRA]

Thanks so much for weighing in. That‘s true about him not doing that well on 2.75u before. Thanks for putting it in perspective. Will try to lobby for a dose increase first thing Monday.

I added some midcycle data from the Libre to the spreadsheet - indicated by L behind number and then manually colored cells. Good tip. It makes it so much easier to process.

I‘m also posting screenshots of the daily graphs below

View attachment 72277View attachment 72278View attachment 72280View attachment 72279

Sorry, yesterday and today are flipped. But you‘ll be able to see the dates on the screenshot.