kse said:
Just got off the phone with the vet--- Kitty has full blown pancreatitis. The lab reference is anything above 5.4 is positive--- Kitty is 13.4.
Everything else checked out ok.
She will start bupe tomorrow and we have a consultation with the vet hospital for a treatment regiment.
This probably gives some validation to why the fluids were helping the bg-- as sub qs are in the protocol for pancreatitis treatment.
The vet kind of wants to go the Lantus route, but I told her one step at a time. First we will work on the pancreatitis, unless the vet hospital says differently. The prozinc was okay until recently-- so, I see no need in changing until we help the pancreatitis.
I was Hoping everything would check out okay. But, I knew something was wrong-- that us why I took her. My gut feeling is -- it could have been a lot worse. Now we have something to work on.
When the day comes that I can pay it forward-- I will have one more area I can help with!
Going to find Laura and Harley....
Hi Kim & Miss Super Kool Kitty Kat!
Thanks for PMing me to let me know about Kitty. I'm sorry I wasn't here sooner and sorry that you both had to join the P-titis club. :sad: I've not been on the board for about 2 weeks now due to 24/7 caring for both Harley & my civvie, Princess. I won't jack your thread with their story though.
I'm glad someone pointed you towards the Yahoo Feline Pancreatitis Support Group. That was the first thing I was going to suggest. They are a great group, very knowledegable, and they have links to articles and resources on the latest treatment protocols.
Regarding the tests that were run, did they also run the cobalamin (vitamin B12) and folate absorption and TLI tests? These are fasting blood tests so if you didn't fast her then it's not likely they did. I ask because the first two, cobalamin and folate, are useful to hep point the way to see if she also has IBD. Many cats that have pancreatitis are also at risk for IBD, diabetes (which we already know she has) and cholangialhepatitis. Thank goodness her liver enzymes are good so as long as she keeps on eating enough, you should be good with Mr. L. It's not necessary to do those tests right now, but if your vet is suggesting starting prednisolone, I'd hold off on it until you find out whether or not she might have IBD. Simple, uncomplicated pancreatitis "should" respond to treatment without resorting to pred. It's when it's continuously being fueled by something chronic like IBD that pred. or budesonide could be useful.
Since you are already doing fluids, my only suggestion there is that unless there is a medical reason why she can not tolerate them (e.g. kidney or heart function), I suggest asking your vet about daily treatments of 100ccs SubQ fluids instead of every 2 days. The pancreas requires adequate perfusion to bring down inflamation. And if she's already getting them every 2 days and still has a specfPL of +13, more fluids would be beneficial.
How often did the vet prescribe bupe? Some vets will say to give only twice a day (every 12 hours) but I've found that TID dosing or even QID dosing when pain is most severe can be necessary. If Miss Kitty's pain is not so severe that she's not eating, it's probably a non-issue. Just wanted to throw that out there in case it becomes necessary.
I believe some folks have already mentioned diet and the possible role of fat content / or lack of it in feline pancreatitis. That is very much an ECID thing. Harley and Princess are sensitive to the fat content of their diets. So the FF classics I'd been feeding for some time were actually too high in fat. Now I'm feeding them the Fancy Feast Elegant Medleys which are lower in fat but higher in carbs. and ProPlan foods that are low fat, mid carb. There is also the theory that raw food because it's low fat and low carb. can be beneficial for pancretitis and IBD. You'll have to weigh the pros and cons of the various options, experiment and see what works best for Kitty. This is uncharted territory for each kitty and mamabean and there really are no wrong answers - just what works for you and Miss Kitty.
I'm glad to hear that she's still eating despite being in pain. That is huge right there. It's when they don't eat that life gets really complicated. I know you aren't there yet, but I'm going to throw this out there on the premise that if you have all the information, you won't need to use it! C'mon Miss Kitty cooperate with Mama Bean please.
If in the future she doesn't eat for you, under no circumstances let your vet give you an appetite stimulant without addressing nausea first. Forcing a cat to eat who doesn't want to eat will create food aversions. And cats have really long memories for these...
Stomach acid reducers:
I see someone else mentioned Pepcid already, as does JoJo. These may be all Miss Kitty needs.
Pepcid AC (famotidine) - This is really useful if kitty is vomiting white foam due to too much stomach acid. It's not an anti-nausea drug though so it won't handle the really strong nausea. But if it's the only thing you have in the house it can be very helpful. A typical dose is 1/4 of a 10 mg tablet 2x daily. If you need stronger doses, it does come in injectible form as well.
Zantac (ranitidine) - Not all cats tolerate Pepcid very well. If they don't, try Zantac 75 tablets instead. Zantac also stimulates gastric motility. A typical starting dose is 1/8 - 1/4 of a 75 mg tablet 2x daily.
Options for nausea medications:
These first 2 are both human anti-nausea drugs used for chemotherapy patients. Quite frankly they are off label use for cats but they are used quite often for cats with IBD and/or pancreatitis.
Zofram (ondansetron) - comes in both injectible form or pills. If you decide to go with pills, get the 4 mg pills, not the 8 mg pills. The usual starting dose is 1/4 of a 4 mg pill (1mg) 2x per day. If you need to start somewhere, start with this drug and be sure to ask for a prescription for the generic. It's A LOT cheaper than the brand name Zofram.
Anzemet (dolasetron) - this comes as an injectible. It's mostly dosed once per day (but can be dosed twice per day if necessary) and dose is based on weight. There is no generic available so it's pretty pricey stuff but is stronger than ondansetron.
Cerenia (maropitant) - This is the drug the ER gave Kitty the night she was vomiting. It lasts anywhere from 24-36 hours. It is approved to treat nausea and vomiting in dogs but is off label use in cats. It really works well though plus I've been reading that it has some antinflamtory effects which is really helpful for GI disease. It comes in injectible and pill form. 4mg per day in the pills is a reasonable starting dose.
Options for appetite stimulants:
Cyproheptadine - comes in pills. Vets for some reason almost always overshoot the dose on these when prescribing. 1/8 to 1/ 4 of a 10 mg pill 2x daily is all that is typically needed to get a kitty eating again. This is VERY bitter so it's best to give as a pill in a gelcap (not a pill pocket) so that kitty doesn't taste it going down.
Mirtazapine - This is actually a human tricyclic anti-depressant drug (Remeron) which is used to stimulate appetite in cats. It's usually given only once every 3 days because it acts on a cats seratonin levels.
Regarding an insulin change, for what it's worth, I think Kitty could benefit from either of the L's when you are ready to make the switch. My personal preference is for Levemir over Lantus, but if your vet will only prescribe Lantus, its a really good insulin. When you get a chance, take a look at Harley's Lev spreadsheet and you'll see how starting with a low dose, holding each dose until it settled in, and gradually raising it, resulted in improved duration and a gradual lowering of the PS's. Up until 2 weeks ago, we were getting really close to regulated, not tightly regulated but regulated. Then his IBD kicked up and %&# went wild. But his most recent spec fPL test from two weeks ago Monday was down to 4 - from a high of 40 on April 1. You might also achevie the same level of control with Lantus. I can't give all the credit to Levemir, but I believe that the longer duration in conjunction with treatment and a lower fat diet (ECID) has sure helped a lot.
Man this is WAY longer than I intended! ohmygod_smile Stepping down off my soapbox and going to get myself some wine to wet my whistle. I'm German so it'll be something white tonight.
(((((((Hugs for you)))))) and head butts for Miss Kitty from bro Harley.
