? 8/22 Shooter AMPS 247, PMPS 187

Max had chronic pancreatitis fur a few years that caused him to become diabetic. How can I help?
 
Hopefully it's okay that I'm asking about my nondiabetic kitty... Koda was diagnosed with Pancreatitis a few months ago because his Spec fPL was off the chart high. He tends to go in cycles of throwing up like maybe once a week or once every few weeks. When he does he throws up maybe hair and bile, maybe just mucousy foamy and usually 3 - 5 times and then he's done. He seeks out plastic to chew on I think to make himself throw up. He of course doesn't want to eat for a little while after but he never goes more than one meal without eating. He doesn't eat a lot at once but he does like to eat small amounts throughout the day. The other issue is he doesn't seem to poop every day. It's more like every couple days, so I started adding Healthy Gut and Miralax to his food. Now I've noticed his poop is light colored and STINKS and is pretty big, like large in diameter (at least compared to the other cats). He rarely seems to have diarrhea and it seems like everything I read - pancreatitis, IBD, EPI talks about diarrhea. Should I have him checked for EPI? How would I know if it's IBD?... Shooter and the diabetes I have a better handle/understanding on. All this intestinal stuff, I feel totally lost...
 
Hi Heather, sorry to hear Koda isn't feeling so well. :( Pancreatitis needs to be managed with anti-nausea meds like Cerenia and ondansetron--did your vet prescribe any of these for Koda? The Healthy Gut contains some prebiotics that will bulk up his stool, as will the Miralax, that's why it's so big. My Ruby who has small cell lymphoma also doesn't get diarrhea very often, it's mostly constipation.

I would ask your vet to do a TLI test that is usually done in conjunction with a test for folate and cobalamin levels. Low levels of these vitamins indicate poor absorption and possible GI disorders like IBD and SCL. If either folate or cobalamin are low, then the next step would be an ultrasound. If the ultrasound shows thickening in the intestines, it could be either IBD or small cell lymphoma but it's hard to tell the difference without a biopsy. Many people will go ahead and treat the cat for either condition with steroids and then if the cat does not respond to that then chlorambucil is given, which is a chemo pill well tolerated by cats.

I went through all of these steps and did the biopsy and got a definitive SCL diagnosis for Ruby. She has never had a pancreatitis diagnosis, but lots of people here have experience with it. It's all super overwhelming, I freaked out about this stuff and still do, but if you can master diabetes, you can master this too. :bighug:
 
Max always became inappetent when he had a bout of pancreatitis. He was nauseous but didn’t vomit so that never occurred to me. He only had diarrhea one time. He did get constipated at times but I think it was the ondansetron which worked really well to get rid of the nausea and get him eating. He did not have IBD. When diagnosed my vet ran a pancreatitis panel to check for EPI but he didn’t have it and never got it after years of chronic pancreatitis. For Max stress brought it on, especially vet visits. My vet and I do think after a few years of pancreatitis it caused him to become diabetic but who knows.
 
PerfumedCatMom said:
Hi Heather, sorry to hear Koda isn't feeling so well. :( Pancreatitis needs to be managed with anti-nausea meds like Cerenia and ondansetron--did your vet prescribe any of these for Koda? The Healthy Gut contains some prebiotics that will bulk up his stool, as will the Miralax, that's why it's so big. My Ruby who has small cell lymphoma also doesn't get diarrhea very often, it's mostly constipation.

I would ask your vet to do a TLI test that is usually done in conjunction with a test for folate and cobalamin levels. Low levels of these vitamins indicate poor absorption and possible GI disorders like IBD and SCL. If either folate or cobalamin are low, then the next step would be an ultrasound. If the ultrasound shows thickening in the intestines, it could be either IBD or small cell lymphoma but it's hard to tell the difference without a biopsy. Many people will go ahead and treat the cat for either condition with steroids and then if the cat does not respond to that then chlorambucil is given, which is a chemo pill well tolerated by cats.

I went through all of these steps and did the biopsy and got a definitive SCL diagnosis for Ruby. She has never had a pancreatitis diagnosis, but lots of people here have experience with it. It's all super overwhelming, I freaked out about this stuff and still do, but if you can master diabetes, you can master this too. :bighug:
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I have some famotidine and a few pills of Cerenia. I give him famotidine if I think his stomach is upset but feel like the Cerenia makes him sick? Maybe it's just because he was having a flare when I gave it to him. I'll definitely ask about these tests. Thank you!
 
tiffmaxee said:
Max always became inappetent when he had a bout of pancreatitis. He was nauseous but didn’t vomit so that never occurred to me. He only had diarrhea one time. He did get constipated at times but I think it was the ondansetron which worked really well to get rid of the nausea and get him eating. He did not have IBD. When diagnosed my vet ran a pancreatitis panel to check for EPI but he didn’t have it and never got it after years of chronic pancreatitis. For Max stress brought it on, especially vet visits. My vet and I do think after a few years of pancreatitis it caused him to become diabetic but who knows.
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So here's the story, one of my kitties passed away unexpectedly. I came home and found him. :( He was 15 and Koda is 15. They mostly grew up together. When I came home none of the other kitties were near him. I think Koda was sleeping on the couch across from him. As I mourned him for the next week, Koda seemed to get sick. He stopped eating, was throwing up, was sleeping a lot, cowering in the corner with his back turned sleeping. I took him to the vet which makes him a nervous wreck and he salivates profusely. They diagnosed him with kidney disease but never tested for pancreatitis. He started eating again. Mostly fancy feast pate and a month later just acted like he didn't feel good. I took him to a different vet where they said he really didn't have kidney disease but had pancreatitis. So this is what I think, I really believe he was DEPRESSED. I never thought cats cared much. No one seemed traumatized when I lost another cat YEARS ago but... they were young. Now they're old. Maybe it affects them more? I don't know, but I really believe he was super sad. So maybe I should get everything checked AGAIN including the tests Katherine mentioned.
 
I'm so sad for Koda. :( I can imagine it has been hard for him to lose his lifelong friend.

I would suggest that you try the Cerenia in conjunction with ondansetron. They both work on different receptors that cause nausea. Cerenia is really good at preventing vomiting and has anti-inflammatory properties that may quell the pancreas flares, while ondansetron is very good at relieving nausea (it's given to human cancer patients who are receiving chemo). Dosage depends on the weight of the cat. The Cerenia is once a day and the ondansetron can be given three times a day. I found that this combination helped get Ruby through her flares before we started prednisolone, but you have to do it consistently for it to work.

Talk about the testing with your vet and let us know what happens. :bighug::bighug::bighug:
 
PerfumedCatMom said:
I'm so sad for Koda. :( I can imagine it has been hard for him to lose his lifelong friend.

I would suggest that you try the Cerenia in conjunction with ondansetron. They both work on different receptors that cause nausea. Cerenia is really good at preventing vomiting and has anti-inflammatory properties that may quell the pancreas flares, while ondansetron is very good at relieving nausea (it's given to human cancer patients who are receiving chemo). Dosage depends on the weight of the cat. The Cerenia is once a day and the ondansetron can be given three times a day. I found that this combination helped get Ruby through her flares before we started prednisolone, but you have to do it consistently for it to work.

Talk about the testing with your vet and let us know what happens. :bighug::bighug::bighug:
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So Koda should be getting these medications on a daily basis even if he’s not in a flare? And outside of occasional bouts of throwing up, how do I know if he’s having a flare? Not only does he eat several times a day, sometimes he’ll start licking his bowl after he just ate 2 hours before.
 
Heather82372 said:
So Koda should be getting these medications on a daily basis even if he’s not in a flare? And outside of occasional bouts of throwing up, how do I know if he’s having a flare? Not only does he eat several times a day, sometimes he’ll start licking his bowl after he just ate 2 hours before.
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The medications are for flares. Vomiting and inappetance are the usual signs, and sometimes a hard or bloated tummy with pancreatitis. Have you read this great sticky that Marje wrote? A Primer on Pancreatitis
 
Heather82372 said:
Hopefully it's okay that I'm asking about my nondiabetic kitty... Koda was diagnosed with Pancreatitis a few months ago because his Spec fPL was off the chart high. He tends to go in cycles of throwing up like maybe once a week or once every few weeks. When he does he throws up maybe hair and bile, maybe just mucousy foamy and usually 3 - 5 times and then he's done. He seeks out plastic to chew on I think to make himself throw up. He of course doesn't want to eat for a little while after but he never goes more than one meal without eating. He doesn't eat a lot at once but he does like to eat small amounts throughout the day. The other issue is he doesn't seem to poop every day. It's more like every couple days, so I started adding Healthy Gut and Miralax to his food. Now I've noticed his poop is light colored and STINKS and is pretty big, like large in diameter (at least compared to the other cats). He rarely seems to have diarrhea and it seems like everything I read - pancreatitis, IBD, EPI talks about diarrhea. Should I have him checked for EPI? How would I know if it's IBD?... Shooter and the diabetes I have a better handle/understanding on. All this intestinal stuff, I feel totally lost...
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I have had several cats with IBD and later SCL over the years. An abdominal ultrasound would be a really good idea for Koda as a first step. Make sure the person doing it is very experienced (preferably a board certified radiologist but I know that is not always possible depending on where people live). In addition to taking a good look around they can measure intestinal thickness, which is very helpful to know. As for the poop … do you think it has a particular odor (or just really stinky)? The vet can send it away for stool testing for pathogens, if necessary. I had a kitty whose diarrhea was not controllable- he did have IBD but also was infected with clostridium perfringens alpha toxin so he had to take a long course of Tylosin. We would not have discovered it without sending the stool out (in this case to University of Georgia) for testing.

Another thing that you really should consider is doing the Texas A&M GI panel testing for Koda. That can tell you a lot about what’s going on and if it looks like IBD or other intestinal disease.
I’m sorry for all of this going on with Koda. :bighug:
 
I forgot to ask what you have been treating Koda’s pancreatitis with? Is he / was he getting medications for that or fluids?
 
Suzanne & Darcy said:
I forgot to ask what you have been treating Koda’s pancreatitis with? Is he / was he getting medications for that or fluids?
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Originally they didn’t give me anything. Now I have gabapentin capsules which seem to be way too strong for him. I don’t like seeing him staggering around & SUPER lethargic. He really only had that one period of time that he didn’t eat and I truly think he was depressed. I think I need another fPL test & the other tests you all have recommended.
 
Heather82372 said:
Originally they didn’t give me anything. Now I have gabapentin capsules which seem to be way too strong for him. I don’t like seeing him staggering around & SUPER lethargic. He really only had that one period of time that he didn’t eat and I truly think he was depressed. I think I need another fPL test & the other tests you all have recommended.
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Yes. Gabapentin is too strong for a lot of cats... they stagger... I've heard it many a time. Buprenorphine is much easier to sort of "titrate" down to a tiny dose, if that is all that is needed. But anyway, you know, I'm sure, about things like fluids, cerenia, zofran if needed, pain control, etc. And if it was just a one time occurrence, it may have nothing to do with the panc. now. I agree about the depression. I have one cat here (Jane) who gets really upset when other of our family cats have died. She usually goes into a downward spiral withing a few days... stops eating and comes down with an upper respiratory infection (most recently it was pneumonia.) It really can happen that depression/grief can send them into a tailspin.
 
Suzanne & Darcy said:
Yes. Gabapentin is too strong for a lot of cats... they stagger... I've heard it many a time. Buprenorphine is much easier to sort of "titrate" down to a tiny dose, if that is all that is needed. But anyway, you know, I'm sure, about things like fluids, cerenia, zofran if needed, pain control, etc. And if it was just a one time occurrence, it may have nothing to do with the panc. now. I agree about the depression. I have one cat here (Jane) who gets really upset when other of our family cats have died. She usually goes into a downward spiral withing a few days... stops eating and comes down with an upper respiratory infection (most recently it was pneumonia.) It really can happen that depression/grief can send them into a tailspin.
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Awe, poor Jane. She's a sensitive soul. :bighug:
 
PerfumedCatMom said:
The medications are for flares. Vomiting and inappetance are the usual signs, and sometimes a hard or bloated tummy with pancreatitis. Have you read this great sticky that Marje wrote? A Primer on Pancreatitis
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I just finished reading the article and find it interesting that 1) the vet never mentioned fasting Koda before the bloodwork and 2) Elise said " It does not always show up in an ultrasound and the SpecfPL only can diagnose when there’s active pancreatitis. Some cats only have one episode, some have acute attacks and for some like Max it comes and goes. The vet’s are starting to think other chronic conditions such as diabetes and kidney disease can cause the blood test to show pancreatitis when it’s not. We stopped testing for it after awhile and I just treated the symptoms."

So all this makes me think that maybe I'll just wait it out, keep my eye on him, monitor his different symptoms, take notes and see... Between Koda's vet visits and Shooter's vet visits and all the different foods and medications... I really shouldn't jump into more testing right now. Unless... several of you REALLY think I should just get a GI panel done for sure? Is this the same as the TLI, folate, cobalamin test that Katherine mentioned?
 
Hi Heather! What do you mean off the charts high? How high was the spec fpl? Sometimes it can stay elevated after a pancreatitis bout has resolved, but in general I tend to be wary about a high value and just keep an eye on kitty anything suspicious is time to go in to vet. I didn't see anyone mention above sub q fluids - that is also an essential part of managing a Pancreatitis attack. And some Buprenex. Pancreatitis can be pretty painful. Yes to the Cerenia too (in fact, Pearl stays on Cerenia year round, it really helps with the Pancreatitis and IBD nausea, and I notice she gets fewer attacks when we stay on it). I keep Bupe in the house for times when it's needed, and am always ready with the sub q. I hope this helps. Also, IBD and Pancreatitis go together, add in liver and you've got Triaditis and it is common for the inflammation to be shared among those organs, they are close together. For IBD, I use novel protein diet that is new (for Pearl that meant venison or duck or beef - she does great on those), and no grains. I hope this information is helpful.
 
Margaret (and Pearl) said:
Hi Heather! What do you mean off the charts high? How high was the spec fpl? Sometimes it can stay elevated after a pancreatitis bout has resolved, but in general I tend to be wary about a high value and just keep an eye on kitty anything suspicious is time to go in to vet. I didn't see anyone mention above sub q fluids - that is also an essential part of managing a Pancreatitis attack. And some Buprenex. Pancreatitis can be pretty painful. Yes to the Cerenia too (in fact, Pearl stays on Cerenia year round, it really helps with the Pancreatitis and IBD nausea, and I notice she gets fewer attacks when we stay on it). I keep Bupe in the house for times when it's needed, and am always ready with the sub q. I hope this helps. Also, IBD and Pancreatitis go together, add in liver and you've got Triaditis and it is common for the inflammation to be shared among those organs, they are close together. For IBD, I use novel protein diet that is new (for Pearl that meant venison or duck or beef - she does great on those), and no grains. I hope this information is helpful.
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Hi Margaret! He said "we don't know the actual number because the chart doesn't go that high." It's IDEXX and the reference range is 0.0 - 3.5 and Koda was 50.0!
As far as the subq's is it needed if he is eating and drinking fine and his skin doesn't tent? No one seems to want to give me Bup here. They have given both Gaba liquid and Gaba capsules. The Cerenia they only gave me 4 24mg tablets that I was cutting in half but man does he fight with anything going into the mouth. lol
 
Heather82372 said:
Hi Margaret! He said "we don't know the actual number because the chart doesn't go that high." It's IDEXX and the reference range is 0.0 - 3.5 and Koda was 50.0!
As far as the subq's is it needed if he is eating and drinking fine and his skin doesn't tent? No one seems to want to give me Bup here. They have given both Gaba liquid and Gaba capsules. The Cerenia they only gave me 4 24mg tablets that I was cutting in half but man does he fight with anything going into the mouth. lol
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Yup, the fluids are needed if he's in an acute Pancreatitis episode - that is how you turn it around. A large number of cats with an acute pancreatitis also go to the hospital for around the clock IV fluids for a few days to help right the episode. To be honest, if you put stock in the spec fpl as a good test, then that numbers definitely indicates hospitalization. I know there are differing opinions here on FDMB about that test and whether it is useful/valid - so I would suggest asking your vet if Koda can turn around at home or whether your vets thinks he needs to go to the hospital. I will tell you that my Whisper was hospitalized last summer with numbers that high (well, started at 7, then went to 12, and then to 40) and I would not hesitate to do it again in a heartbeat. How is Koda feeling? I cannot believe with a spec fpl that high that your vet will not give Bupe - almost inhumane. Pancreatitis attack is quite painful, and if that number accurately reflects what he is dealing with, then there is a lot of inflammation. Are you getting an ultrasound? That will really help see the state of the pancreas and how inflamed it is/how severe the attack is. I would do that immediately and not hesistate it if was my Whisper. Does this help you? I will tag @Butters & Lyla who has also had a lot of Pancreatitis experience and has hospitalized before. How is Koda's appearance and behavior? How long do you think he has been dealing with this?
 
Margaret (and Pearl) said:
Yup, the fluids are needed if he's in an acute Pancreatitis episode - that is how you turn it around. A large number of cats with an acute pancreatitis also go to the hospital for around the clock IV fluids for a few days to help right the episode. To be honest, if you put stock in the spec fpl as a good test, then that numbers definitely indicates hospitalization. I know there are differing opinions here on FDMB about that test and whether it is useful/valid - so I would suggest asking your vet if Shooter can turn around at home or whether your vets thinks he needs to go to the hospital. I will tell you that my Whisper was hospitalized last summer with numbers that high and I would not hesitate to do it again. How is Shooter feeling? I cannot believe with a spec fpl that high that your vet will not give Bupe - almost inhumane. Pancreatitis attack is quite painful, and if that number accurately reflects what he is dealing with, then there is a lot of inflammation. Are you getting an ultrasound? That will really help see the state of the pancreas. I would do that immediately and not hesistate it if was my Whisper. Does this help you? I will tag @Butters & Lyla who has also had a lot of Pancreatitis experience and has hospitalized before. How is Shooter's appearance and behavior? How long do you think he has been dealing with this?
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Koda is actually my pancreatitis/early kidney kitty. Shooter has the diabetes. Pepper has been throwing up more lately, so I think it's his turn for bloodwork next. :arghh:
Koda was just diagnosed with pancreatitis 05/27/21.
 
Heather82372 said:
Koda is actually my pancreatitis/early kidney kitty. Shooter has the diabetes. Pepper has been throwing up more lately, so I think it's his turn for bloodwork next. :arghh:
Koda was just diagnosed with pancreatitis 05/27/21.
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Yeah, I got messed up on the names as I was writing! I am not positive your vet is up on how severe Pancreatitis can be if not recommending fluids, Bupe, and ultrasound STAT with the test knowledge you have currently. From what my experience has been I would move on those right away at this point. How is Koda's behavior?
 
Heather82372 said:
I just finished reading the article and find it interesting that 1) the vet never mentioned fasting Koda before the bloodwork and 2) Elise said " It does not always show up in an ultrasound and the SpecfPL only can diagnose when there’s active pancreatitis. Some cats only have one episode, some have acute attacks and for some like Max it comes and goes. The vet’s are starting to think other chronic conditions such as diabetes and kidney disease can cause the blood test to show pancreatitis when it’s not. We stopped testing for it after awhile and I just treated the symptoms."

So all this makes me think that maybe I'll just wait it out, keep my eye on him, monitor his different symptoms, take notes and see... Between Koda's vet visits and Shooter's vet visits and all the different foods and medications... I really shouldn't jump into more testing right now. Unless... several of you REALLY think I should just get a GI panel done for sure? Is this the same as the TLI, folate, cobalamin test that Katherine mentioned?
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Yes. The Texas A&M GI panel is $76 and is the same as the one Katherine mentioned. Your vet may add on a charge to that, but that is the price that the lab charges to do the blood testing. I understand. If Koda is eating and not vomiting and not having diarrhea then I might wait myself. That’s not advice but I am just saying from a practical standpoint that if my vet bills were really high (well my vet bills are always high) I might hesitate to do more stuff all at once.
 
Heather82372 said:
several of you REALLY think I should just get a GI panel done for sure?
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The TAMU test is easy enough to do. It can tell you a lot of things. It wasn't as cheap for me as what Suzanne said because I live in NYC where nothing is cheap and they have to FedEx the bloodwork to Texas. Even so, Ruby's results did not show anything abnormal, so we were sent home to manage the symptoms until she stopped eating more frequently. It becomes more worrisome when the cat doesn't eat, because that can cause all sorts of dire issues like hepatic lipidosis. And you know what happens when a diabetic cat does not want to eat. :rolleyes:
 
PerfumedCatMom said:
The TAMU test is easy enough to do. It can tell you a lot of things. It wasn't as cheap for me as what Suzanne said because I live in NYC where nothing is cheap and they have to FedEx the bloodwork to Texas. Even so, Ruby's results did not show anything abnormal, so we were sent home to manage the symptoms until she stopped eating more frequently. It becomes more worrisome when the cat doesn't eat, because that can cause all sorts of dire issues like hepatic lipidosis. And you know what happens when a diabetic cat does not want to eat. :rolleyes:
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I think I may have paid about $150 by the time the blood draw and FedExing and stuff was added on!
 
Margaret (and Pearl) said:
Yeah, I got messed up on the names as I was writing! I am not positive your vet is up on how severe Pancreatitis can be if not recommending fluids, Bupe, and ultra
sound STAT with the test knowledge you have currently. From what my experience has been I would move on those right away at this point. How is Koda's behavior?
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Outside of his occasional throw up bouts he seems fine. He eats good, he does seem to drink a lot of water and pees quite a bit though.
 
Are there other forms of cerenia and ondansetron besides pills? Liquid is hard too but might be easier than pills. He FIGHTS (not bites) for me to put ANYTHING in his mouth. I love transdermal stuff. Lol What about bupranex? Gabapentin liquid he runs around foaming at the mouth BAD.
 
You can get Cerenia injected, but it stings and the vials are expensive if you want to do it at home. I only know of pill form for ondansetron that I cut up into small pieces and I wrap it with ¼ or less of a pill pocket. I have the liquid form of buprenex that my vet put into prefilled syringes.
 
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