11/09 Tansi in hospital with pancreatitis, please see update below

I have heard from the internal medicine vet. Tansi has eaten some of the ff pate and freeze dried turkey I provided. He did not require a feeding tube. The vet has also fed him gastro food that I specifically asked them not to do. They have also skipped two insulin doses because they are concerned that he will hypo at a bg level of 8 and he is being tested every 2 hours there. The doctor had his spreadsheet that I provided but has not looked at it. She was unfamiliar with the tight regulation protocol and kept reminding me about the dangers of a hypoglycemic episode.
She says his dose is too high and she will reduce it. I suggested that skipping doses and lowering the dose might lead to trouble in a few days as the depot empties but she feels his glucose is low and he may be going into remission with those low numbers. I feel like this is unlikely with an inflamed pancreas.
Then she had to rush off because if an emergency.
What do you all think?
Also she said she didn't know what to make if me using a human meter and so she was unable to comment on what those numbers meant.
 
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At a dose of 2.25U no he's not nearing remission yet, but his numbers do look really good.

If you look at Mr Kitty's spreadsheet from this year on March 15th, you'll see his numbers did start to come down with pancreatitis treatment. He does have IAA so it's also possible it's coincidence.

I'd tell her that he's your cat, you are paying (quite a bit I'm sure) for a service. If anything, consider a small reduction, but she needs to stop skipping. This sounds harsh, but if she had any marbles rolling around in her head, she'd know that the inappetence and inflammation/stress that comes with pancreatitis is a big risk for ketones. The insulin is your last line of defense, especially with them giving the other food

If he were my cat, I'd expect they manage his diabetes as I'm requesting, minimal negotiation like a slightly reduced dose.

Are they doing anything that you couldnt do at home? Because realistically I'd be discharging him and taking him home.
 
One million thanks for your thoughts.
I am thinking the same.
What is IAA?
I'm afraid I may have jumped down her throat a bit when she said she skipped two doses, and when she gave him high carb gastro food "to stop the vomiting." He last vomited four days ago!
After telling me that she had never heard of tight regulation, she later said it had not been proven effective by veterinary endocrinologists?!
I would like to bring him home as I am sure his numbers will be wild. I did agree to a small dose decrease but who knows what that means? A full unit?
He has a fever and a catheter for fluids. I am pretty sure they want to do another ultrasound before he comes home too.
I am totally comfortable with sub q fluids and administering meds.
I am half a mind to bring him home and half a mind afraid to because I know so little about pancreatitis.
She seems to be more concerned about possible IBD than his diabetes since the ultrasound showed mild intestinal inflammation. The emerg doctor said that's not uncommon for widespread inflammation with pancreatitis.
Cost is not so much of a concern fortunately, but already at 3000 and not convinced he is getting gold service!
 
First and foremost, I pray for speedy recovery.

How bad is the pancreatitis? Do you think you can manage it at home. Treatment is supportive care. Anti nausea, pain med appy stimulant if needed, anti vomiting meds. Maybe subq fluids and B12 shots are not a bad idea.

Regardless of what meter you use, a low is a low and a high is a high. What do they consider low? An IM in ER by me who does take on normal primary care, told me she likes to keep cats in the 200s (U.S. measurement, I don't remember the conversion). Needless to say I did not go to her.

Next is the skipping of insulin. remind them DKA happens if not enough insulin, infection (pancreatitis in this case), and not eating. A lot of cats will eat the a/d food. Yes it's higher in carbs, but you need them to eat so they get the insulin. You just dose around the glucose. Pancreatitis comes first. You can always get insulin back on track. I

Yes I know you don't want to go backwards. Sometimes you have to. When my Ollie had her 1st pancreatitis it lasted 6 weeks. She was never hospitalized. It was really hard to keep up with it, but I got into a routine, slept on couch so I could hear her. My vet was good and kept me supplied with all the meds. Ollie did eat though, maybe not a lot but enough.
 
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First and foremost, I pray for speedy recovery.

How bad is the pancreatitis? Do you think you can manage it at home. Treatment is supportive care. Anti nausea, pain med appy stimulant if needed, anti vomiting meds. Maybe subq fluids and B12 shots are not a bad idea.

Regardless of what meter you use, a low is a low and a high is a high. What do they consider low? An IM in ER by me who does take on normal primary care, told me she likes to keep cats in the 200s (U.S. measurement, I don't remember the conversion). Needless to say I did not go to her.

Next is the skipping of insulin. remind them DKA happens if not enough insulin, infection (pancreatitis in this case), and not eating. A lot of cats will eat the a/d food. Yes it's higher in carbs, but you need them to eat so they get the insulin. You just dose around the glucose. Pancreatitis comes first. You can always get insulin back on track. I

Yes I know you don't want to go backwards. Sometimes you have to. When my Ollie had her 1st pancreatitis it lasted 6 weeks. She was never hospitalized. It was really hard to keep up with it, but I got into a routine, slept in couch so I could hear her. My vet was good and kept me supplied with all the meds. Ollie did eat though, maybe not a lot but enough.
Thank you so much for your thoughts.
When she calls back I will bring up ketones again. I did mention it earlier and she said that ketones were extremely unlikely at his bg numbers!
I better get some ketone sticks, I should have by now anyway. Just in case his numbers so drop dramatically as pancreas heals. I am fortunate to be home with him almost all the time.
What is the fastest way to get ketone test strips?
The doctor said she he does not need insulin at all today!!! I got her to agree to give it if at his next reading he is above 8, with a small decrease.
Any recommendations on food welcome.
What he did eat was the ff pate and freeze dried turkey. That's why I was pissed off they also threw in the gastro food?
If he us eating the ff as usual, should I supplement with gastro food? Is it helpful fir pancreatitis?
 
IAA is insulin auto antibody... basically his antibodies attack the insulin I give, so in turn have to keep increasing the dose to the point they're overwhelmed and the insulin can get through.

The fever would concern me a bit, do they think that's from pancreatitis or something else?

Like Paula said pancreatitis is scary but manageable, you find a groove with the meds and possible assist feeds. There are plenty of us here with experience with it as well.
 
Thank you so much for your thoughts.
When she calls back I will bring up ketones again. I did mention it earlier and she said that ketones were extremely unlikely at his bg numbers!
I better get some ketone sticks, I should have by now anyway. Just in case his numbers so drop dramatically as pancreas heals. I am fortunate to be home with him almost all the time.
What is the fastest way to get ketone test strips?
The doctor said she he does not need insulin at all today!!! I got her to agree to give it if at his next reading he is above 8, with a small decrease.
Any recommendations on food welcome.
What he did eat was the ff pate and freeze dried turkey. That's why I was pissed off they also threw in the gastro food?
If he us eating the ff as usual, should I supplement with gastro food? Is it helpful fir pancreatitis?
Do they have him on pain medication? Even if you get rid of nausea and vomiting, the pain can also make them not want to eat.

It's more important that he eats, anything. Can always adjust the insulin. They can develop an aversion to food they eat when not feeling well, or if syringe fed. So I'd grab some food he doesn't usually eat.

More often than not I have to assist feed for a few days, so I also keep syringes on hand for that.
 
IAA is insulin auto antibody... basically his antibodies attack the insulin I give, so in turn have to keep increasing the dose to the point they're overwhelmed and the insulin can get through.

The fever would concern me a bit, do they think that's from pancreatitis or something else?

Like Paula said pancreatitis is scary but manageable, you find a groove with the meds and possible assist feeds. There are plenty of us here with experience with it as well.
My goodness IAA is yet another wrench in the machinery! Well done on you!
Doctor said fever not uncommon?
 
Do they have him on pain medication? Even if you get rid of nausea and vomiting, the pain can also make them not want to eat.

It's more important that he eats, anything. Can always adjust the insulin. They can develop an aversion to food they eat when not feeling well, or if syringe fed. So I'd grab some food he doesn't usually eat.

More often than not I have to assist feed for a few days, so I also keep syringes on hand for that.
Yes on the pain meds
Understood on the food, thank you
I will get food syringe in case.
Any food to absolutely avoid? Emerg doc said hi fat is bad.
Thanks for so much help. ❤
 
When he is discharged, the will probably give you 3 or 5 days with of meds. Not nearly enough. Acute pancreatitis does not go away in 3 days. Flare up yes, IF you start meds right away.

Call your primary vet and try to get 30 days worth of meds. Maybe 2 cans of Rx a/d or Royal Canine Recovery food. If Tansi is hard to medicate, he might eat it in the food. Refrigerate open can. Maybe using compound pharmacy or human might be cheaper than meds from vet. Ollie ended up on low maintenance pain med dose. She also was acro and had abdominal mass.

My non diabetic Tux has triaditis (3 major organs involved). Pancreatitis, gall bladder infection, liver inflammation. Been treating since mid September. Labs done every 2 weeks. It's his liver that is most concerning. Alt values (12-130) has been to high for machine to read, over 1600 and 1700s. Until yesterday it was normal at 51. Vet said I can give pain med and ondansteron as needed. He hasn't needed ondansteron much. But his abdomen still hurts him, so I'm going to try 1/2 dose of pain med for awhile.

Cerenia is packaged for dogs, but given to cats also. Very popular.

Antiemetic is different than antinausea. Cerenia and ondansteron work together very well as it's processed differently.
 
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When he is discharged, the will probably give you 3 or 5 days with of meds. Not nearly enough. Acute pancreatitis does not go away in 3 days. Flare up yes, IF you start meds right away.

Call your primary vet and try to get 30 days worth of meds. Maybe 2 cans of Rx a/d or Royal Canine Recovery food. If Tansi is hard to medicate, he might eat it in the food. Refrigerate open can. Maybe using compound pharmacy or human might be cheaper than meds from vet. Ollie ended up on low maintenance pain med dose. She also was acro and had abdominal mass.

My non diabetic Tux has triaditis (3 major organs involved). Pancreatitis, gall bladder infection, liver inflammation. Been treating since mid September. Labs done every 2 weeks. It's his liver that is most concerning. Alt values (12-130) has been to high for machine to read, over 1600 and 1700s. Until yesterday it was normal at 51. Vet said I can give pain med and ondansteron as needed. He hasn't needed ondansteron much. But his abdomen still hurts him, so I'm going to try 1/2 dose of pain med for awhile.

Cerenia is packaged for dogs, but given to cats also. Very popular.

Antiemetic is different than antinausea. Cerenia and ondansteron work together very well as it's processed differently.
Many thanks for your thoughts.
You certainly have your hands full!
 
When he is discharged, the will probably give you 3 or 5 days with of meds. Not nearly enough. Acute pancreatitis does not go away in 3 days. Flare up yes, IF you start meds right away.

Call your primary vet and try to get 30 days worth of meds. Maybe 2 cans of Rx a/d or Royal Canine Recovery food. If Tansi is hard to medicate, he might eat it in the food. Refrigerate open can. Maybe using compound pharmacy or human might be cheaper than meds from vet. Ollie ended up on low maintenance pain med dose. She also was acro and had abdominal mass.

My non diabetic Tux has triaditis (3 major organs involved). Pancreatitis, gall bladder infection, liver inflammation. Been treating since mid September. Labs done every 2 weeks. It's his liver that is most concerning. Alt values (12-130) has been to high for machine to read, over 1600 and 1700s. Until yesterday it was normal at 51. Vet said I can give pain med and ondansteron as needed. He hasn't needed ondansteron much. But his abdomen still hurts him, so I'm going to try 1/2 dose of pain med for awhile.

Cerenia is packaged for dogs, but given to cats also. Very popular.

Antiemetic is different than antinausea. Cerenia and ondansteron work together very well as it's processed differently.
Thank you!
 
@FrostD
@tiffmaxee
@Bandit's Mom

Tansi will PROBABLY be discharged tomorrow.
The vet will have skipped 4 doses by the time we get home. She refused to give insulin when he was in the normal range. She insisted he was likely on remission, staying between 7 and 8 all day on pet meter.
I said that he was likely at those numbers due to his 2.25 doses previous to admission, with the depot draining. I told her that I expected a great big increase in bg in a day or two as the depot completely drained. It is her understanding that this is impossible because lantus does not last that long. This is why, she said, lantus is given twice a day. Because it runs out fast. I am certain you all feel my frustration.
Anyways
I know I will need lots of advice in the coming days as I deal now not only with pancreatitis, but also his messed up glucose levels.
He is coming home with a weeks worth of cerenia and gabapentin and mitrazapine, sub q rig, and 3 days worth of bupenorphine. He is being weaned off fentanyl now.
I am getting everything ready for ketone testing at home.
I am getting medium carb food in case he won't eat his usual ff. I know it's extremely important that he eats, and the insulin can be adjusted. He will only get the mc if he needs encouragement to eat at all.
Is there anything else?
Thank you all.
I will update info tomorrow about bg overnight.
.
 
I don’t understand these vets. I’ve never seen a cat go from 2.25 to otj. Don’t worry though. We will help you with dosing. He wasn’t inappetent for long so he should be happy to eat his lc. I’m glad he’s improved and will be coming home. Any idea what they were feeding him?
 
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Thank you so very much.
I don't know what I would do without all this help.
They are supposed to be feeding him the food I brought which was ff pate and freeze dried turkey. Despite my explicit instructions and I even taped a note to the food NO DRY FOOD, NO PRESCRIPTION WET FOOD, they still felt the need to throw in some gastro food too, even tho he was already eating what I brought.
And I am 4 grand in so far.
 
@tiffmaxee
Any thoughts appreciated when you have time. I can't find the condo where you recommended something inplace of cerenia, was it odesterone?
Yes. Get an RX for ondansetron. Some cats do better with it when nauseous, some with cerenia, and some need both as they work differently. Did you have fluids in case needed? I’d get a bag of LRS just in case. Has Tansi ever
r had ketones? I don’t recall. Max had chronic pancreatitis for a few years before diabetes but never had ketones with flares after fd. He was never hospitalized for more than a night. Inflammation goes along with pancreatitis. With IBD there’s thickening of the intestines. That was not mentioned. It seems to me at least at this point all the symptoms are from pancreatitis. Don’t worry about that right now.

Get a copy of the complete chart, ultrasound, and labs. It will come in handy later to compare should he have other flares. I get every record. I learned the hard way how important that is.
 
I don’t think you will need recovery food. Max was given his regular food always. You can get meds from an online pharmacy or Costco if there’s one near you. I disagree about putting medicine in the food. it can turn him off the food. I used empty gel capsules and chased them with Gerbers baby food all meat which most cats love. I do agree you might need the medication for a month or more but it is his first time with pancreatitis so you don’t know yet.
 
That is very very helpful advice, I will get the records for sure.
I asked for ondansetron and she said cerenia is more bio available or something. I can try again tomorrow but I think she has just about had it with me lol.
I am getting fluids
He does not have history of ketones, I just want to be prepared for anything.
His ultrasound showed some inflammation of liver and intestine. One doctor said this can happen due to pancreatitis, the im doctor was more concerned and sent a gi panel to texas.
 
I don’t think you will need recovery food. Max was given his regular food always. You can get meds from an online pharmacy or Costco if there’s one near you. I disagree about putting medicine in the food. it can turn him off the food. I used empty gel capsules and chased them with Gerbers baby food all meat which most cats love. I do agree you might need the medication for a month or more but it is his first time with pancreatitis so you don’t know yet.
No problem, I don't put meds in food, I am pretty good at adminitrating meds if I do say so myself.
Will try to get that baby food
What is odesteron called in human form, do you think I can get it over the counter? In Canada
 
No problem, I don't put meds in food, I am pretty good at adminitrating meds if I do say so myself.
Will try to get that baby food
What is odesteron called in human form, do you think I can get it over the counter? In Canada
Zofran. You can’t get it over the counter and I think it’s expensive in Canada unfortunately. It’s cheaper than cerenia in the US as we use the generic. It’s a human drug originally used by human cancer patients for nausea and for several years used for nauseous pets.
 
Is it cheaper if you buy 30 at a time or 8mg and cut them up?
No, not cheaper. More drugs only save you the future cost of the prescribing fee.

Splitting the generic 8mg does not save you all that much.

The dissolvable name brand Zofran 4mg costs $7 or $8 per.

It is a small price to pay when you can't stop puking your guts up.
 
I asked for ondansetron and she said cerenia is more bio available or something.
There have been very recent studies showing ondansetron is much better than Cerenia for nausea. Definitely get the generic ondansetron. Zofran brand I asked for quote for laughs, and a 4 mg pill was $16!!! I pay a little over $4 for generic. Do shop around, you can also pay $5 in BC.

You can also buy injectible ondansetron, but might have to shop around more for pharmacies that sell it. I don't think it's cheaper, but easier to give if cat isn't feeling like eating. Fortunately current recipient of ondansetron takes it in pill pocket. I do the pill, not dissolvable.
 
Ideally get Miritaz, which is a paste form of mirtazapine that you just rub into the ear. It absorbs more slowly than the pill, and much less likely to have the bad side effects. There's a reason it's nick-named meowzapine.
I am getting the gel for the ears, and I have used it before on my IBD cat Bill. Yes, it works a charm!
 
Sending prayers for both you Cindy and Tansi. It looks like you are prepared for almost anything. Happy Tansi is coming home especially to get his insulin back on track. It sounds like you know what to do for Tansi far more than the vet and hospital. You also have this wonderful forum that has knowledge and experience to help you through any crisis. Ketone Blood meters are also wonderful if you have problems with the using ketone strips. Only issue with the meters are that the strips are so expensive. You can buy them on Amazon if you have an account or possibly most pharmacies. I used a
KETODOC Advanced Ketone Blood... https://www.amazon.com/dp/B07VQFTJ3F?ref=ppx_pop_mob_ap_share

Sending hugs and prayers to you and Tansi :bighug::bighug::bighug::bighug: I hope he starts feeling better soon especially with you to love and care for his needs.
 
Sending prayers for both you Cindy and Tansi. It looks like you are prepared for almost anything. Happy Tansi is coming home especially to get his insulin back on track. It sounds like you know what to do for Tansi far more than the vet and hospital. You also have this wonderful forum that has knowledge and experience to help you through any crisis. Ketone Blood meters are also wonderful if you have problems with the using ketone strips. Only issue with the meters are that the strips are so expensive. You can buy them on Amazon if you have an account or possibly most pharmacies. I used a
KETODOC Advanced Ketone Blood... https://www.amazon.com/dp/B07VQFTJ3F?ref=ppx_pop_mob_ap_share

Sending hugs and prayers to you and Tansi :bighug::bighug::bighug::bighug: I hope he starts feeling better soon especially with you to love and care for his needs.
What a lovely post, thank you for your kind wishes!
I picked up a new cat box and 5 big bags of unpopped popcorn hahaha
I will set up if he goes quite high.
I couldn't find the hydrophobic litter anywhere!
 
Sending prayers for both you Cindy and Tansi. It looks like you are prepared for almost anything. Happy Tansi is coming home especially to get his insulin back on track. It sounds like you know what to do for Tansi far more than the vet and hospital. You also have this wonderful forum that has knowledge and experience to help you through any crisis. Ketone Blood meters are also wonderful if you have problems with the using ketone strips. Only issue with the meters are that the strips are so expensive. You can buy them on Amazon if you have an account or possibly most pharmacies. I used a
KETODOC Advanced Ketone Blood... https://www.amazon.com/dp/B07VQFTJ3F?ref=ppx_pop_mob_ap_share

Sending hugs and prayers to you and Tansi :bighug::bighug::bighug::bighug: I hope he starts feeling better soon especially with you to love and care for his needs.

I second the recommendation for the ketone blood meter. Far easier than urine strips, since you're already doing glucose checks. (I can usually get both glucose and ketone measurements from the same ear poke.) And they actually test for a different form of ketone that is more useful for detecting possible DKA.
 
They also have the ketone and glucose meter all in one unit. :bighug:
Trying not to confuse today's and yesterday's threads - but seconding this. I have the NovaMax Plus, ADW usually runs specials where the meter is free if you buy strips (if they ship to you). Its my backup glucose meter. It's much less stressful knowing you can get ketones from an ear poke any time vs waiting and hoping to catch them in the box
 
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