4/10 Fred +4 308, AMPS 365, +3 348 Pancreatitis dx

I received Fred's official labs yesterday. His spec fPL came back at 5.7, with a normal range going up to 3.5. So...officially pancreatitis. I am so completely discouraged and so very sad for him. I see pancreatitis in so many signatures, so I know it can be a hand in hand diagnosis with diabetes. But it literally makes me cry. Don't our poor babies have enough to deal with already having diabetes?

In early January, about two weeks after Fred was diagnosed, his fPLl was 3.4. About two weeks later, it was 3.5. By 2/22, he was at 4.1, and I could tell at that time he wasn't feeling great. Now...we've really made it official with both the labs and his symptoms.

The good news is, he seems to be doing basically well except for his one really bad night. Additionally, all his other numbers are normal, with the exception of an elevated BUN (put down to dehydration) and elevated cholesterol. He's received Cerenia each day, but no pain meds, as my mobile vet didn't appreciate pain during her exam. And he has been eating well. In fact, last night, he was all over me for food. He has also been put on a 7 day course of Veraflox, because I suspect something in the urinary area as well. But he is not himself; he's lethargic.

His glucose...now that's another story. I'm so incredibly frustrated because we were FINALLY getting somewhere. I just don't know if this is a chicken and the egg situation. Have I not been able to regulate him because of (initial) low-grade pancreatitis, or is the pancreatitis a result of not being able to regulate him? Because he was in the normal range when we started out, as well as having a normal ultrasound, I'm thinking the latter.

To those of you who have been through it, I have a few questions to which I'd so appreciate any insight.

a) how long do the attacks tend to last?

b) Is this something that can resolve if I ever manage to get him regulated? I've seen even beautifully regulated cats like @Butters & Lyla have attacks. (and I hope Butters is feeling better today!!) Or will we always be waiting for it to pop up again? What worries me is that his fPL has just continued a steady climb.

c) I've seen supplements listed...milk thistle, etc. Is there anything anyone has used that they have found particularly useful or effective? He's already on a milk thistle supplement; has been for years.

Sorry for the novel. So disheartened today.

 

Hi! Ok so about the spec fpl. It is a good test. However when dealing with chronic pancreatitis it maaay not be the best identifier of where your cat is at, because once the pancreas is inflamed, the spec fpl sometimes doesn’t ever go back down even when an acute attack is over. Something to keep in mind.

A good rule of thumb I follow with Pearl re her pancreatitis flares is to treat symptomatically. When she starts having what I know or suspect is an attack, I ramp up the supportive care - sub q fluids, Cerenia, Buprenex, making sure she eats. I usually don’t take her in for blood testing. If the attack worsens or does not respond to treatment we go in (and at that point I usually know hospitalization is on the horizon). But it hasn’t gotten to the point of taking her in. And PS your Fred’s number is not that bad!!! It is really pretty consistent so far. I would personally not worry about testing frequently an rather treat the attacks and take in for testing only when the treating isn’t working. My opinion. Because the test numbers can drive one crazy.

My other cat Whisper (black kitty in profile pic) flew over the rainbow bridge in September due to a severe pancreatitis attack. When that happens you know that you know you need help beyond what you can do at home. She was hospitalized 4 days. They waited several days and didn’t want to do a spec fpl even because the results may not help know what level of improvement she was at, assuming she was improving. Ultimately I did do one, the night before she passed and it was 40(!!!) plus multi system organ failure so no coming back from that. She had gone from 7 to 40 in a week. And trust me, you KNOW when this is happening.
I hope these meandering thoughts give you some additional thoughts to consider.

 

Ok one more. Attacks last how long they last - no rule of thumb. Doing supportive care at home is essential.

Pearls BG usually goes up during attacks then comes down after they are done, but not always.

If you’re doing the supportive care at home with no improvement and slow declines in his personality affect look etc, I would personally take in to hospital and get on an IV drip for a few days to reset and head anything severe off. Most also have oxygen tanks which can help as well.

 

Here's your last condo - https://www.felinediabetes.com/FDMB/threads/4-7-fred-pmps-476-3-321.245873/

Sorry about the dx but from what I understand pancreatitis can be managed. I am sure this link may have been posted before but there is a ton of info in the Primer On Pancreatitis post - https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

Hugs to you and Fred. Hang in there

 

I'm sorry I can't help answer your questions and I'm sorry about the diagnosis. @tiffmaxee knows a lot about pancreatitis and she made a comment today in my condo that the Spec fPL number doesn't show you how sick or bad a cat feels. When Butters had an acute attack back in October, she ended up being hospitalized for five days. Her Spec fPL was "only" 9.1. Her Spec fPL number runs above normal even when by all accounts she seems to be feeling good.

Butters had pancreatitis before the diabetes showed up. She just wasn't officially diagnosed with chronic pancreatitis until November 2020, because her previous vets were not very good and didn't recognize all of the signs. And I didn't know enough to ask them about it . But, I've managed to get her tightly controlled in spite of chronic pancreatitis, and Elise (tiffmaxee) had her diabetic kitty Max tightly controlled too in spite of his having chronic pancreatitis. So it is possible.

 

Poor Fred, looks like he's bouncing on top of it. There are a few conditions that can cause insulin resistance, meaning, harder but not impossible to regulated. Anything involving infection or inflammation is included on that list, which means pancreatitis. Having those supportive meds on hand so you can start them as soon as you see them is a good idea. Glucose toxicity is another condition that is a sort of insulin resistance, and the cure is patience and eventually getting to that dose that moves Fred.

Neko once scored 14.7 on that specfPL level. She was having other issues at the time on top of it, that was just before her diagnosis for GI IBD/lymphoma and her heart condition. She was on fluids and bupe for other conditions at the time, just not the Cerenia or ondansetron. Her BG wasn't bad at the time. But I had to stop fluids for the sake of her heart, bit of a juggling act.

I once saw someone say B12 helped pancreatitis episodes, but I don't know if that was just another issue that cat had. Anyway, if you are getting blood work done sometime, might be worth adding a B12 level test to the list. Cats that are low on B12 feel better with supplementation.

 

So at times Max had a SpecFpl of 50! He didn’t present as feeling worse than when it was 5 or 10. We stopped running the test mostly and treated his symptoms as @Margaret (and Pearl) does. You lean what works for your cat. The first sign of trouble with Max was that he became inappetent. So if his appetite decreased he got ondansetron. Used buprenorphine sparingly for pain as he didn’t always appear to be in pain.

I posted an article yesterday I think on pancreatitis I recommend reading. Let me get the link.

https://felinediabetes.com/FDMB/thr...acute-and-chronic-pancreatitis-1-2021.245949/

 

Thank you, everyone, for your responses. We needed to take a rainy Sunday yesterday and remember to treat Fred like a cat, not a patient. He even played a bit!

I'm so terribly sorry @Margaret (and Pearl) to hear about Whisper. Your profile photo is beautiful. Thank you all for sharing your stories and insight, especially when it comes to the fPL number. Fred seems to be sensitive to it right now...meaning even the "small" increase made him feel pretty lousy. But, and probably, unfortunately, if he is developing something chronic, the number may mean less and less.

@Wendy&Neko I was really hoping he was in a bounce, but he's just been high and flat for 3 days now. I'm thinking it could be a result of the pancreatitis. He had a pretty fast drop last night at about +80 minutes, and we finally saw a yellow at +5. So I hope whatever the resistance is is breaking. Fred does definitely feel better. He did well with no meds yesterday and was on me all night for food. He's just had his third dose of Veraflox, and his urination has gone back to pretty much where it's been for the last month or so. Whether that's timing or the ABX...I'll take it. I actually would have liked to increase this AM, but with everything going on, I didn't know if this was the time. He may just need to break something, and I don't want him diving.

Oh, and Fred gets B-12 weekly. I started that last month because I always think it's a great pick-me-up for any cat. Now, with the pancreatitis, I'm very glad I have it on board. We were going to do a B12/folate test the other day, but my vet said he needed to have fasted.

Thanks again, everyone!

 

Most find with pancreatitis the numbers go up until the episode has passed . B12 is not normally given for pancreatitis. To test you need your cat to be off B12 but. I can’t remember for how long.