Belle 5/1 - UPDATE- Acute Pancreatitis

[Jason & Belle (GA)]

UPDATE:

Just returned from the hospital and she has acute pancreatitis. I haven't done any reading about this, but according to the doctor, the prognosis is excellent. It will take some time and care, but Belle should be coming home. I thank you all for your kind words and support. Belle has so many issues, I was beginning to lose hope.

Not so funny story from the hospital. I was told this morning that they would not be feeding her until after her ultrasound. I called twice during the day to ask if she had eaten, and both times they said she was given food, but wouldn't eat. I packed her favorite stuff for my visit and asked the Nurse if I could try and feed her as she always eats for me. She said no problem. Belle ate 3/4 of a can of Blue Wilderness Duck, her probiotic with chicken gravy, and would have eaten the rest of the can if I let her. I was thrilled. As soon as she was done eating, the nurse came in and told me she wasn't supposed to be fed, that they were with holding food. I then realized they thought it was pancreatitis. Too late, she ate. I hope I didn't set back her recovery much, but boy, it did my heart good to see her eat

Jason




Hey everyone,

This will be a little long. Belle seemed to be doing fine over the last few weeks, other than a stomach bug that Amoxicillin cleared up. Wednesday of this week, she had two vomiting episodes that brought up only foam and a few kibble. She was eating fine, and thought nothing of it. Thursday morning, she had a small foamy vomit. This, along with the fact that she didn't have a morning bowel movement worried me. I called my vet, and he couldn't see me, so I debated brining her to emergency. She seemed to be eating less, but she was eating and did eat her portion of Blue Wilderness both in the morning and at night. By the evening, she still didn't have a bowel movement and I told my wife if she didn't by the morning, she was going to emergency. I thought she might have a blockage.

She didn't throw up Thursday night and Friday morning there was a normal, large bowel movement from Belle. She was eating normally again so I was relieved, and didn't bring her to emergency. At 6:30PM Friday night, she had a dry heave. She ate her whole dinner at 9:00PM and seemed fine. At 9:15PM she went into the litter box, and as is my routine these days, I followed. She urinated, and it was a bright yellow. I freaked, and checked her gums, and she was jaundiced. I didn't notice any jaundice in her eyes or ears. She is orange, so jaundice is hard to see. I rushed her to the vet, and the bloodwork showed an ALT of 4000. She is obviously in serious condition. She has had elevated ALT before, as high as 1600 or more, but antibiotics lowered it significantly. This time, she was on Amoxicillin for the stomach bug, so it's unlikely to be an infection.

I saw her this morning, and she is alert and loving. I brought her food, pills, and insulin. They are planning to do an ultrasound so they said they wouldn't feed her until after that. When I got home, I called to see if they had tried to feed her, and they had put out the Blue Buffalo, but she didn't eat it. I told them to put out her dry food to see if she'd eat that. That was my one hope, that she was eating when she went in, and now it seems she is not. They haven't done the ultrasound yet, so no idea what's really happening. She had had an enlarged liver in the past, but didn't do a liver biopsy because of poor clotting. She also had Hemobartonella a month or so back with anemia. That was treated, but I read that can also cause Jaundice. Her hemocrit levels were lower this time, but I don't know if that would affect her ALT this much.

My question is this. I've read that Diabetes can cause Hepatic Lipidosis, even in cats that haven't stopped eating. Have any of you experienced this? She's only had it a month or so, so it's a new variable that she hasn't dealt with before. The outcome here is Cancer, HL, Inflammation or infection. I don't think its infection becasue she was on Amoxicillin for the past two weeks. It could be inflammation, but this would be a huge escalation of what we've seen in the past. Cancer has always been on the table, but a biopsy was never possible due to her other conditions. So that leads me to HL, and the thought that her Diabetes could be the cause. Cancer is the worst outcome, as all the others are treatable to some extent.

Any feedback or experiences would be helpful, as I'm beside myself right now. She is my baby, and I feel helpless. I wish I could be optimistic, but after each new crisis, I find it harder and harder to believe she has the strength to pull through.

Jason

 

[Blue]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

I truly wish I had something to say other than I have had no issues with mine other than pancreatitis, but certainly others will come along that can answer.
What about putting something more eye catching in your subj?

 

[Jason & Belle (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

I didn't want to put 911 in the title since I know, ultimately, I'll need to wait for the doctors to give me a diagnosis. I just needed to get it out, and any feedback would be a bonus.

I truly wish I had something to say other than I have had no issues with mine other than pancreatitis, but certainly others will come along that can answer.
What about putting something more eye catching in your subj?

 

[Michelle & Scrabble (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

Just wanted to say we are all here for you! Hopefully someone will come along to help! Hugs! Sending healing vines to your kitty!

 

[Hillary & Maui (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

You may want to cross post this on health to get more people (non-lantus users) to see and possibly comment too.

I hope you get answers soon.

 

[Blue]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

Maybe if you had something like ALT 4000 in your subj, or some other vital detail you will catch the eyes of those with experience. You could add HL and more bits if you replace hospital
Good luck with replies.

 

[Jill & Alex (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

(((jason))) hang in there. get the diagnosis and go from there. cats are amazingly resilient creatures.

six weeks ago alex appeared to be on death's doorstep. she was diagnosed with severe liver disease and in an acute renal crisis. her gall bladder, duct, liver, and kidneys were involved. her ALT was 594 (normal 10 - 100). making sure she ate her "normal" amount of calories plus another half of that daily was a number one priority. in retrospect, having a feeding tube placed would have been much easier. antibiotics, administering sub-q fluids spiked with B complex and B12 vitamins, denamarin, and ursodiol were all part of the treatment for her. we're continuing to taper down the amount of sub-q fluids, but she's still on denamarin and ursodiol. her labs have improved quite a bit. it took a lot of hard work, but if her behavior today is any indication... she's doing pretty darn well. her next round of blood work will give us a better idea. i have no idea what your vet will suggest based on a diagnosis.

there are several peeps on the board who have successfully dealt with HL. cyn/cosmo and lynee/max immediately come to mind. there are many, many more who are very familiar with liver and kidney disease as well as cancer. once you know what the problem is, there are peeps here to support you.

like i said before, hang in there. i know how incredibly worrisome it is when our kitties are having health problems...

 

[Jason & Belle (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

Done. Thanks.

Maybe if you had something like ALT 4000 in your subj, or some other vital detail you will catch the eyes of those with experience. You could add HL and more bits if you replace hospital
Good luck with replies.

 

[Jess & Earl]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

Jason I'm so sorry to hear your kitty is so sick. Is she at a specialty hospital, under the care of an internal medicine specialist?

This will be a little long. Belle seemed to be doing fine over the last few weeks, other than a stomach bug that Amoxicillin cleared up.

I wonder about this. You mean she was vomiting? Did your vet do any bloodwork at that time? X-rays?

I rushed her to the vet, and the bloodwork showed an ALT of 4000. She is obviously in serious condition. She has had elevated ALT before, as high as 1600 or more, but antibiotics lowered it significantly. This time, she was on Amoxicillin for the stomach bug, so it's unlikely to be an infection.

It may or may not have an infectious component; amoxi is not effective against many types of bugs so we can't count on it having treated any type of infection.

She also had Hemobartonella a month or so back with anemia. That was treated, but I read that can also cause Jaundice. Her hemocrit levels were lower this time, but I don't know if that would affect her ALT this much.

Is she still undergoing treatment for hemobartonella (now officially called mycoplasma)? She probably would have been on Baytril or doxycycline for at least three weeks. It causes jaundice because of the destruction of the red blood cells; liver problems cause jaundice for another reason.

Have they done another coagulation profile? It sounds like she needs to get a biopsy. Does the hospital do laprascopic procedures? Did they do the ultrasound? Do you have copies of her bloodwork? I'd like to know her other liver enzyme numbers such as AST and ALP and GGT. Also she should have a urine culture done.

I've read that Diabetes can cause Hepatic Lipidosis, even in cats that haven't stopped eating.

I haven't heard of this. Some cats are very prone to HL, and so can develop it easily even if there is just a brief dip in appetite, but it really is a disease of (usually fat) cats who don't eat. The diabetic connection comes from the fact that the cats are usually obese and the diabetes implies pancreatic inflammation, making a case for an easily-irritated liver. Also, some cats develop the triple whammy of DKA, HL, and pancreatitis. For your kitty we're worried about pancreatitis and possible GI disease (IBD); the inflammation along the GI tract can "shower" the liver with bacteria and provoke serious liver damage and inflammation.

The ALT enzyme specifically indicates liver cell death. (I know a lot about this because my beloved dog Elliott has chronic hepatitis and his liver is slowly dying.) When the ALT is this high it indicates a crisis--something is attacking the liver such as infection, or there is hypoxic (lack of oxygen) damage. It's possible that a massive destruction of red blood cells could overwhelm the liver and cause damage but you'd want to see this during an intense phase of mycoplasma. I dont' have a clear enough idea of your kitty's clinical picture but it's something to speak to the internist about.

I wish I could be optimistic, but after each new crisis, I find it harder and harder to believe she has the strength to pull through.

Her high ALT is definitely worrisome, but if she's somewhere with an internist and 24 hour care she's in the best hands. Don't hestiate to allow a feeding tube placement, ok? That is a likely next step.

Important drugs to ask about are Actigall [as long as they know her gall bladder isn't blocked up], vitamin K (to support clotting) and liver support drugs such as Denosyl, Marin, or the combo product called Denamarin. She should have a urine culture done, a repeat mycoplasma test, and be started already on antibiotics that can target mycoplasma (like doxycycline) and liver disease such as metronidazole.

Please keep us poste.d

 

[Jason & Belle (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

Jason I'm so sorry to hear your kitty is so sick. Is she at a specialty hospital, under the care of an internal medicine specialist?

Thanks for the well wishes. She is an a specialty hospital with 24/7 care. She is being seen by an Internal Medicine specialist, although not her usual one.

This will be a little long. Belle seemed to be doing fine over the last few weeks, other than a stomach bug that Amoxicillin cleared up.

I wonder about this. You mean she was vomiting? Did your vet do any bloodwork at that time? X-rays?

Sorry for not explaining. No vomiting, just liquid smelly diarrhea. It went away after two days on the AB. Nothing was done at the time because she was at the vet the week before and the bloodwork was unremarkable, for her at least.

I rushed her to the vet, and the bloodwork showed an ALT of 4000. She is obviously in serious condition. She has had elevated ALT before, as high as 1600 or more, but antibiotics lowered it significantly. This time, she was on Amoxicillin for the stomach bug, so it's unlikely to be an infection.

It may or may not have an infectious component; amoxi is not effective against many types of bugs so we can't count on it having treated any type of infection.

That made me a feel a bit better, though it was Clavamox that helped the last time.

She also had Hemobartonella a month or so back with anemia. That was treated, but I read that can also cause Jaundice. Her hemocrit levels were lower this time, but I don't know if that would affect her ALT this much.

Is she still undergoing treatment for hemobartonella (now officially called mycoplasma)? She probably would have been on Baytril or doxycycline for at least three weeks. It causes jaundice because of the destruction of the red blood cells; liver problems cause jaundice for another reason.

Have they done another coagulation profile? It sounds like she needs to get a biopsy. Does the hospital do laprascopic procedures? Did they do the ultrasound? Do you have copies of her bloodwork? I'd like to know her other liver enzyme numbers such as AST and ALP and GGT. Also she should have a urine culture done.

She did her 3 weeks of Doxycycline and her hemocrit went from 17% to 40%. As of last night, she was at 29%. I agree she does need a biopsy, and one was scheduled a month or two ago, but her clotting wasn't right and the DR decided against it. They are supposed to run another clotting test today. They can do Laprascopic procedures and will be doing an ultrasound. I don't have copies of her bloodwork, but they didn't mention anything other than her ALT last night. In the past her ALT was the only abnormal value.

I've read that Diabetes can cause Hepatic Lipidosis, even in cats that haven't stopped eating.

I haven't heard of this. Some cats are very prone to HL, and so can develop it easily even if there is just a brief dip in appetite, but it really is a disease of (usually fat) cats who don't eat. The diabetic connection comes from the fact that the cats are usually obese and the diabetes implies pancreatic inflammation, making a case for an easily-irritated liver. Also, some cats develop the triple whammy of DKA, HL, and pancreatitis. For your kitty we're worried about pancreatitis and possible GI disease (IBD); the inflammation along the GI tract can "shower" the liver with bacteria and provoke serious liver damage and inflammation.

The ALT enzyme specifically indicates liver cell death. (I know a lot about this because my beloved dog Elliott has chronic hepatitis and his liver is slowly dying.) When the ALT is this high it indicates a crisis--something is attacking the liver such as infection, or there is hypoxic (lack of oxygen) damage. It's possible that a massive destruction of red blood cells could overwhelm the liver and cause damage but you'd want to see this during an intense phase of mycoplasma. I dont' have a clear enough idea of your kitty's clinical picture but it's something to speak to the internist about.

In the past, the thought was that her IBD was causing the Liver issues. This is a whole nother level though. My best to Elliott.

I wish I could be optimistic, but after each new crisis, I find it harder and harder to believe she has the strength to pull through.

Her high ALT is definitely worrisome, but if she's somewhere with an internist and 24 hour care she's in the best hands. Don't hestiate to allow a feeding tube placement, ok? That is a likely next step.

Important drugs to ask about are Actigall [as long as they know her gall bladder isn't blocked up], vitamin K (to support clotting) and liver support drugs such as Denosyl, Marin, or the combo product called Denamarin. She should have a urine culture done, a repeat mycoplasma test, and be started already on antibiotics that can target mycoplasma (like doxycycline) and liver disease such as metronidazole.

Please keep us poste.d

Thanks for your insight. She is getting the best care possible(hopefully). I will discuss the medications with them. I have no issue with a feeding tube, but I'm hoping she hasn't stopped eating. She didn't eat her wet food this morning, but that's not unusual. If she hasn't touched her dry, then I'm worried.

Jason

 

[Jason & Belle (GA)]

Re: Belle 5/1 - In the Hospital- ? about Diabetes and the Liver

Jill,

Your story gives me hope. HL is just a guess, and a questionable one based on the fact that she never stopped eating. If she hasn't eaten today, then I'm open to a feeding tube. I'm am definitely willing to do anything, including keeping her hospitalized, to get her through this.

I hope Alex's next round of bloodwork is back to normal!

Jason

(((jason))) hang in there. get the diagnosis and go from there. cats are amazingly resilient creatures.

six weeks ago alex appeared to be on death's doorstep. she was diagnosed with severe liver disease and in an acute renal crisis. her gall bladder, duct, liver, and kidneys were involved. her ALT was 594 (normal 10 - 100). making sure she ate her "normal" amount of calories plus another half of that daily was a number one priority. in retrospect, having a feeding tube placed would have been much easier. antibiotics, administering sub-q fluids spiked with B complex and B12 vitamins, denamarin, and ursodiol were all part of the treatment for her. we're continuing to taper down the amount of sub-q fluids, but she's still on denamarin and ursodiol. her labs have improved quite a bit. it took a lot of hard work, but if her behavior today is any indication... she's doing pretty darn well. her next round of blood work will give us a better idea. i have no idea what your vet will suggest based on a diagnosis.

there are several peeps on the board who have successfully dealt with HL. cyn/cosmo and lynee/max immediately come to mind. there are many, many more who are very familiar with liver and kidney disease as well as cancer. once you know what the problem is, there are peeps here to support you.

like i said before, hang in there. i know how incredibly worrisome it is when our kitties are having health problems...

 

[Kelly & Logan]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

I'm so sorry, Jason. I hope they can get you some answers soon. She's at CVS, right? What internist is working the ER this weekend? Logan sees Dr Hopwood (not a huge fan, but she's ok - getting better). I've heard excellent things about Jaeger from several people. That's who I wanted Logan to see but he went through the ER service and Hopwood was the one working.

Logan has had HL twice. He is very prone to getting it so just a small dip in his eating can bring it on - that's why I panic when he stops eating well. He had a feeding tube placed when they did the exploratory surgery in January - they biopsied his liver, stomach, pancreas and small intestines. They did a PEG tube, which I do not recommend. They are more risky than the e-tube that's placed into the esophagus through the neck. Logan developed a really bad bacterial infection as a complication of the PEG tube. I have no doubt the PEG tube saved his life, though. The infection almost killed him, however. Just ask them to go over the pros and cons of both types before making a decision. The tube was really scary to me, but we got used to it. Logan would not eat after the surgery. The PEG tube has to stay in a minimum of 10 days, while the e-tube can be taken out at any time once the cat starts eating again. Logan would not eat at the ER, either.

I hope they can give you some answers soon. Hugs to you both. I know how awful this is. It's so hard to see them hurting in any way. And I know exactly what you mean about it getting harder and harder to stay optimistic each time you suffer a setback. Hang in there, we'll be thinking of you.

 

[Lisa and Do Lou (GA)]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

I am so sorry Jason 4000 is so high of a reading this is what I do for a living animal bloodwork I myself have never seen a reading this high in a cat in my 16 yrs as a tech I truly wish you the best of getting her turned back around and home with you I have seen high liver cases turned around many times so I know it can happen prayers and healing vines being sent your way :YMHUG: :YMHUG: :YMHUG:

 

[Jason & Belle (GA)]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

Thanks Kelly,

Dr. Hopwood is the Internal Dr. there this weekend. She is not off to a great start with me. It's 4:00 and she has yet to call despite my calling in 3 times. The only things I know for sure is she has not eaten, and she is on AB and fluids. When I went this morning they said they didn't want to feed her before the Ultrasound, but nobody can tell me if it's even been done at this point. Certainly, I'm no expert, but unless you can get HL while still eating, I find it hard to believe. Her appetite dipped about 2 weeks ago with the liquid diarrhea, but that only lasted two days and she did eat. She put that weight back on within a few days. I'm hoping infection, but I fear the worst. It's all the more frustrating getting no information. I'm going to visit her at 6, so hopefully I'll know more then.

As for the PEG tube, my CRF cat had it, and it worked well, but was difficult to keep clean and she too ended up with an infection. I'm not sure that would even be an option for Belle in her condition. She has so many other things going on that surgery hasn't been an option lately. I'm actually open to keeping her in the hospital to get her better. It would cost a ton, but she would get round the clock care.

Jason

I'm so sorry, Jason. I hope they can get you some answers soon. She's at CVS, right? What internist is working the ER this weekend? Logan sees Dr Hopwood (not a huge fan, but she's ok - getting better). I've heard excellent things about Jaeger from several people. That's who I wanted Logan to see but he went through the ER service and Hopwood was the one working.

Logan has had HL twice. He is very prone to getting it so just a small dip in his eating can bring it on - that's why I panic when he stops eating well. He had a feeding tube placed when they did the exploratory surgery in January - they biopsied his liver, stomach, pancreas and small intestines. They did a PEG tube, which I do not recommend. They are more risky than the e-tube that's placed into the esophagus through the neck. Logan developed a really bad bacterial infection as a complication of the PEG tube. I have no doubt the PEG tube saved his life, though. The infection almost killed him, however. Just ask them to go over the pros and cons of both types before making a decision. The tube was really scary to me, but we got used to it. Logan would not eat after the surgery. The PEG tube has to stay in a minimum of 10 days, while the e-tube can be taken out at any time once the cat starts eating again. Logan would not eat at the ER, either.

I hope they can give you some answers soon. Hugs to you both. I know how awful this is. It's so hard to see them hurting in any way. And I know exactly what you mean about it getting harder and harder to stay optimistic each time you suffer a setback. Hang in there, we'll be thinking of you.

 

[Jason & Belle (GA)]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

Thanks Lisa. Until I noticed the jaundice last night, she was acting pretty normal and eating. Hopefully that means we caught whatever it is early, and she'll make it through. I'm expecting the worst and hoping for the best. She's come through so much that I would never count her out.

Jason

I am so sorry Jason 4000 is so high of a reading this is what I do for a living animal bloodwork I myself have never seen a reading this high in a cat in my 16 yrs as a tech I truly wish you the best of getting her turned back around and home with you I have seen high liver cases turned around many times so I know it can happen prayers and healing vines being sent your way :YMHUG: :YMHUG: :YMHUG:

 

[Sienne and Gabby (GA)]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

I'm so sorry to hear this about Belle. My thoughts are with you both. Cats are remarkably resilient creatures. I hope you hear back from the vet soon. Please post whatever lab results they send you.

 

[Blue]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

It's probably no consolation but my vet does all her calls at the end of her workload. I can't expect her to call me if she is booked solid with a day full of dentals which has happened.
What I did was to ask the reception to ask a quick question in passing and if reception could call me with the answer. That's what was done for me because all I wanted was the answer that was a simple yes or no.

I am now used to having my message added to the pile of call-backs and then I do my part by having a written list of my questions/concerns ready to ask when she calls.
Maybe you could try something like that?

 

[Jason & Belle (GA)]

Re: Belle 5/1 - ALT 4000- Possible HL from Diabetes?

I usually have no problem waiting for a call, and I am used to my usual doctor getting back to me at end of day. This though, I needed to know what her diagnosis was, and what we need to do. That said, the doctor was very nice and the news was better than expected, so I'm happy.

Jason

It's probably no consolation but my vet does all her calls at the end of her workload. I can't expect her to call me if she is booked solid with a day full of dentals which has happened.
What I did was to ask the reception to ask a quick question in passing and if reception could call me with the answer. That's what was done for me because all I wanted was the answer that was a simple yes or no.

I am now used to having my message added to the pile of call-backs and then I do my part by having a written list of my questions/concerns ready to ask when she calls.
Maybe you could try something like that?

 

[Roni and Moonie]

Just sending healing vines & get well snowflakes to Belle & hope she gets better real real soon--

 

[Kelly & Logan]

So glad it's not HL. I don't have any experience with Acute Pancreatitis. Will she have to stay in the hospital? What's the treatment plan? Dr Hopwood is very nice, but she's not as responsive as I would like, either. Like I said before, she has gotten better lately. I call and bug the h*ll out of the front desk staff. I don't think they like me very much!

We'll continue to keep you and Belle in our thoughts and prayers.

 

[Sienne and Gabby (GA)]

This is great news! I'm going to include some links we have about pancreatitis -- there are lots of kitties here who have had an acute flare or who have chronic pancreatitis.

The first is a link that Jojo posted -- she's a vet tech who has been with this board forever. She's currently not here with as much regularity due to some health issues of her own. This is a quick intro on what you need to have in your toolkit to manage this. She refers to pancreatitis as a pepsid deficiency.

This is a link that will give you more educational information on both diagnosis and treatment. It's a roundtable discussion by experts in the area of feline pancreatitis.

 

[Jason & Belle (GA)]

Awesome. I'll read through the links tonight. When all is said and done, I'll be knowledgeable about every feline disorder known to man.

Jason

This is great news! I'm going to include some links we have about pancreatitis -- there are lots of kitties here who have had an acute flare or who have chronic pancreatitis.

The first is a link that Jojo posted -- she's a vet tech who has been with this board forever. She's currently not here with as much regularity due to some health issues of her own. This is a quick intro on what you need to have in your toolkit to manage this. She refers to pancreatitis as a pepsid deficiency.

This is a link that will give you more educational information on both diagnosis and treatment. It's a roundtable discussion by experts in the area of feline pancreatitis.

 

[Jess & Earl]

Hi Jason

I almost missed your update because it was added to the first post; the link in the update emails takes me to the last post.

Just returned from the hospital and she has acute pancreatitis.

As the internist may have mentioned, pancreatitis rarely occurs in a vacuum. You're likely also dealing with chronic GI disease or some kind of underlying liver disease. This still needs to be sorted out for the long term. Did they tell you anything else about the results of the ultrasound? Anything about the gall bladder or bile duct?

The ALT is still very, very high for me to say "oh, it's just simple pancreatitis". Are they treating her with lots of antibiotics as well? Actigall (aka ursodiol)? Denamarin?

As soon as she was done eating, the nurse came in and told me she wasn't supposed to be fed, that they were with holding food. I then realized they thought it was pancreatitis.

Was this before her ultrasound? There is no other reason to fast, cats do not do well with fasting and you have a cat with liver damage to boot. Perhaps the nurse is mistaken.

 

[Blue]

Ah, p-titis! It's the only problem I have ever really had with Shadoe, so I can relate.
I really don't understand the no eating as that's just sounding wrong. And what about that crazy ALT value?

I was TERRIFIED that she was so sick. She was not eating and sitting in her meatloaf position and I felt so sick with worry!

I rushed her in to the vet office and the end was that I brought her home with pain meds, nausea meds, and fluids to give her. The vet tech showed me at the office how to give fluids myself and I was nervous but caught on quickly.

Most definitely get pain meds; from all that I have been told, it's quite painful when there's an attack. I got prefilled shots to give for the first few days, and then I got some trandermal gel to rub on the insides of Shadoe's earflaps. She did not like the gel much, I guess it made her feel funky but my other kitty LOVED the stuff and licked the excess off her ears!

You can take care of the treatment yourself; hopefully, any other issues will be not serious.

The needle for the fluids is much larger and Shadoe was not all that comfy with it; she actually slinked away one time and the fluids were leaking all over haha_smiley from that time on, I made sure I held her secure by my side and she had now opportunity to sneak away. The fluids when first going in felt weird to me because you can literally feel the big bulge, but it's ok as it dissipates quite quickly and you will notice Belle acting better too.

There are plenty of people who have experience with pancreatitis on the board, so lots of people can answer any questions you may have. The good thing is that you now may know signs to watch for any repeat attack.

You will just have to wait and hear what else is causing some of the problems. Will the dr be giving you A/B and continue looking at the reason for that ALT number?

 

[Jason & Belle (GA)]

Gayle,

The no eating is supposed to settle the pancreas, but she said there are different thoughts about fasting. She and my regular internist believe in it, others do not. Once she is stabilized and the inflammation of the gallbladder duct is no longer a concern, I will have her home to take care of. I'm comfortable doing everything necessary. Unfortunately, I've tried Buprenorphine before(and still have 13 syringes full) and she doesn't do well on it. I know cats can hide pain, but she seems to be ok.

She is and I expect will be on AB's, and I did ask about the liver. She didn't seem concerned and expected it to improve with the AB's, fluid, and whatever is done for the pancreas. I will be asking much more about that tomorrow. I know she has had liver inflammation in the past, but that number is just off the charts.

Jason

Ah, p-titis! It's the only problem I have ever really had with Shadoe, so I can relate.
I really don't understand the no eating as that's just sounding wrong. And what about that crazy ALT value?

I was TERRIFIED that she was so sick. She was not eating and sitting in her meatloaf position and I felt so sick with worry!

I rushed her in to the vet office and the end was that I brought her home with pain meds, nausea meds, and fluids to give her. The vet tech showed me at the office how to give fluids myself and I was nervous but caught on quickly.

Most definitely get pain meds; from all that I have been told, it's quite painful when there's an attack. I got prefilled shots to give for the first few days, and then I got some trandermal gel to rub on the insides of Shadoe's earflaps. She did not like the gel much, I guess it made her feel funky but my other kitty LOVED the stuff and licked the excess off her ears!

You can take care of the treatment yourself; hopefully, any other issues will be not serious.

The needle for the fluids is much larger and Shadoe was not all that comfy with it; she actually slinked away one time and the fluids were leaking all over haha_smiley from that time on, I made sure I held her secure by my side and she had now opportunity to sneak away. The fluids when first going in felt weird to me because you can literally feel the big bulge, but it's ok as it dissipates quite quickly and you will notice Belle acting better too.

There are plenty of people who have experience with pancreatitis on the board, so lots of people can answer any questions you may have. The good thing is that you now may know signs to watch for any repeat attack.

You will just have to wait and hear what else is causing some of the problems. Will the dr be giving you A/B and continue looking at the reason for that ALT number?

 

[Jason & Belle (GA)]

Hi Jason

I almost missed your update because it was added to the first post; the link in the update emails takes me to the last post.

Just returned from the hospital and she has acute pancreatitis.

As the internist may have mentioned, pancreatitis rarely occurs in a vacuum. You're likely also dealing with chronic GI disease or some kind of underlying liver disease. This still needs to be sorted out for the long term. Did they tell you anything else about the results of the ultrasound? Anything about the gall bladder or bile duct?

The ALT is still very, very high for me to say "oh, it's just simple pancreatitis". Are they treating her with lots of antibiotics as well? Actigall (aka ursodiol)? Denamarin?

As soon as she was done eating, the nurse came in and told me she wasn't supposed to be fed, that they were with holding food. I then realized they thought it was pancreatitis.

Was this before her ultrasound? There is no other reason to fast, cats do not do well with fasting and you have a cat with liver damage to boot. Perhaps the nurse is mistaken.

I thought I replied to your post, but I must have deleted it by accident.

Belle definitely has GI issues. We think it's IBD, but could be cancer. We haven't been able to do a biopsy because of her other issues. She has a lot of issues, so my only goal is to get her over this hump and deal with the next thiing when it comes. And it will come.

As for the fasting, it was after the ultrasound, and they definitely wanted to withhold food. From what I was told, it's meant to settle the pancreas. I've heard this before, so I wasn't surprised. She also said some believe in it, some don't. Personally, I don't see how eating can be bad, but I'll defer to the two doctors on this one. Since I fed her, she wasn't fasted and I feel better that she will eat on her own.

Jason

 

[Blue]

Phew, so long as Belle is going to be OK.

I worry about no eating, and even feel squeamish to fast for some of Shadoe's tests.
Then again, I am Ukrainian, and food matters haha_smiley

Sorry the bupe does not sit well with Belle; I hope you can get some alternative for any pain.

I hope Belle comes home soon to you.

 

[Jason & Belle (GA)]

Thanks Gayle, you and everyone here have been a huge help to me today.

Jason

Phew, so long as Belle is going to be OK.

I worry about no eating, and even feel squeamish to fast for some of Shadoe's tests.
Then again, I am Ukrainian, and food matters haha_smiley

Sorry the bupe does not sit well with Belle; I hope you can get some alternative for any pain.

I hope Belle comes home soon to you.

 

[WCF and Meowzi]

As for the fasting, it was after the ultrasound, and they definitely wanted to withhold food. From what I was told, it's meant to settle the pancreas. I've heard this before, so I wasn't surprised. She also said some believe in it, some don't. Personally, I don't see how eating can be bad, but I'll defer to the two doctors on this one. Since I fed her, she wasn't fasted and I feel better that she will eat on her own.

Jason

The current thinking for both pancreatitis in dogs and cats is to offer nutritional support, not to fast. See Idexx's Treatment Recommendations for Feline Pancreatitis dated Oct. 2008. Specifically, "Experts recommend enteral nutritional support in all patients with pancreatitis. The historical recommendation of nothing per os (NPO) for animals with pancreatitis is no longer accepted. In addition, cats can develop hepatic lipidosis if not provided adequate calories. The new dogma has become this: if the gastrointestinal tract works, use it; and if the patient is vomiting, give an antiemetic so that they keep the food down. Enteral nutrition stabilizes the gastrointestinal barrier, improves enterocyte health and immune function, improves gastrointestinal motility, prevents catabolism and decreases morbidity and mortality."

This is a comparison of Pancreatitis In Dogs Versus Cats but I find it useful as a quick at-a-glance reference.

 

[jojo and bunny]

hi jason, i am sorry your kitty is so sick.
and i couldn't read fast enough so i could get to the point where i could type, glad WFC has already opened the door to what i need to say...absolutely NO fasting for a diabetic cat with p-titis, especailly with liver involvement! as it is there is a cloud of possible DKA hovering, withholding calories, no no no, very wrong thing to do imho. cats are not small dogs (many vets fast p-titis canines, but i do not once remember a vet i ever worked with fast ANY p-titis feline), fasting p-titis felines was taken off table long ago as approved treatment and being diabetic and with her other issues, i am just sitting here shaking my head 'no' so hard it might pop off my neck and roll across room any minute. i am hoping that the tech was mistaken (do not know why fasting for the u/s would have been needed) and just meant that was only in plans just until u/s was done, not as a tx plan! can you call and find out? i am very concerned about this.

ps. also highly recommend the feeding tube, kitty might have eaten for you today but with an ALT like that and everything else going on there is no guarantees that level of eating on own will continue and force feeding a cat the true amount of calories needed is extremely difficult. (ask jill, she is probably going to sleep for a month now that alex is finally eating on own. she has been doing nursing care around the clock trying to get all into alex that she needed). a feeding tube makes everything sooo much easier. i really have yet to meet someone who isn't muttering to themselves around week 2 'why the heck didn't i stand in vet's lobby and scream that i wanted a feeding tube and am not leaving until i get it!' the old saying "feeding tubes save lives" is very true.

if you could get your hands on the full blood work (how was the dx of p-titis made? was an fPLI test done? or from the u/s?) and scan in in would love to see it. curious about the rest of the liver values.
~jojo

oh and pps. naturally agreed with everything jess said, remember you can ask for things like a urine C&S, it is your right as owner.

and one more thing i just saw you wrote: "Unfortunately, I've tried Buprenorphine before(and still have 13 syringes full) and she doesn't do well on it. I know cats can hide pain, but she seems to be ok."
can you explain what you mean by didn't do well on it? what pre-measured dose is in those syringes? maybe was just wrong dose. p-titis (and btw, with that ALT and jaundice, etc, i also do not feel that she has just straight p-titis, this is a combination of a few things going on at once) IS a very painful condition. there is a post on the LL back up board by a LL-er that is a human diabetic that had a p-titis flare and she describes what it really feels like, which cats are so good at hiding. pain meds are big part of the tx.

i know we are throwing a lot at you at once, i'm sorry. but your kitty needs you to be very proactive and speak up for her and make sure vets explain everything to you in detail, anything you do not understand ask and let them explain (we will also help you in addition). you have a lot to get familiar with all at once.