? Likely a pancreatitis diagnosis...what should I know before talking to the specialists?

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Sandi and Toby

Sandi and Toby

Member Since 2015
Hi All,

Sorry this is long. For how and why Whisper came to join our family of 7 (2 human, 5 feline), you can see http://www.felinediabetes.com/FDMB/threads/new-member-whisper-but-not-newly-diabetic.145785/ You might see a theme with me, because that is long too!

So what happened about a month after coming to us, and having already been through ear infections, infected gums, full dental with extractions, etc, since then is that he developed diarrhea. We assumed it was from either a change in food from Meow Mix dry at the rescue to FF classics here, or the antibiotic, because he did have normal poo when we first got him.

After two weeks of liqui-poo that didn't respond to Flagyl and Fortiflora, or a diet change from FF Beef to FF Chicken, the vet they took X-rays and didn't see anything horrible (bloodwork/urine/stool was normal too), so instead of getting a mobile ultrasound, they wanted to do a referral to NCSU Vet School since we live 20 minutes from there. Then, if NCSU wanted to do an aspirate they could, while the mobile ultrasound could not, and we might still end up at NCSU regardless. Fortunately, we got an appointment the NEXT DAY because of a cancellation, rather than 3 weeks away as scheduled originally. Yay! That was last Tuesday.

We got the full workup, blood, urine, stool, ultrasound, they did an aspirate of an enlarged lymph node. Nothing conclusive in the blood or fructosamine other than high BG, which we know, and the viewing of the enlarged lymph node and a slight thickening of the bowel. Unfortunately, they didn't get enough cells from the lymph node to know much of anything. They gave dewormer since he had come from a rescue living with dozens of cats (cage-free) even though 3 stool tests had been negative. We did the dewormer last Wed/Th/Fri nights.

To backup, these are his symptoms: diarrhea. That's it. He is delightful, he is happy, he loves to play, he loves to snuggle with his mama and dad, he loves to chase his youngest sister up the indoor cat tree, he eats like a horse, his eyes are bright, he is only as lethargic as any other 10-14 year old indoor cat I have ever known. From the pancreatitis symptom list (http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.79693/) he has exactly one. Diarrhea. Even for as long as he has had diarrhea, he isn't showing as dehydrated on the tent test, but his urine was slightly concentrated on analysis. He gets his FF Chicken Feast Classics watered down 50:50.

On a call on Sunday night, NCSU wanted to schedule an endoscopy/colonoscopy, and do more lymph node and liver biospsies. A couple of things. I had *just* read about Gracie being at the ER in pain after endoscopy, but glad it was only gas, plus had read a little about whether endos were really that conclusive. Plus I really hate to keep doing this stuff to our new little boy unless necessary. So we decided against doing it right away unless he deteriorates quickly. Instead wanted to go conservative while Whisper is still eating, liqui-pooping, staying hydrated, etc. So instead we got the Texas A&M Univ Spec fPL test and NCSU was going to talk to the nutritionist and we are going to try a diet change (hypo or novel protein) and see what the test shows. I haven't ever had a cat with GI issues. My regular vet called with the results today and said that the lipase that should be under 3.5 was 19... :-( But she wanted to talk to our IM doctor at NCSU before we make a plan, and she will call me later tonight or tomorrow. BTW, I don't have a copy of the actual results yet, but will get them tomorrow. Cobalamin (sp?) was also low.

My question is this. Other than what is in the pancreatitis primer, what do you think I should know/ask when she calls to discuss? Do you think there is much doubt about it being pancreatitis with this result? Could it still be IBD? Could it still be lymphoma? And for treatment, even though he doesn't have the other symptoms, would I do well to ask for some bupe, ondansetron/cerenia, cypro, and fluids to have on hand if it is pancreatitis to avoid a $$$ visit to the NCSU ER (because we know that bad things only happen on weekends, holidays or at night!), or would it be enough of a change in his symptoms that the ER would be the best choice anyway?

Thanks for any advice you can give, I just want to be as prepared as possible. On the plus side, I get to kiss his soft velvet belly when we cuddle, but I would much rather he be healthy instead...

whisper_velvet_belly.JPG

Thanks!
Sandi & Whisper
 
Sorry I don't have any advice to offer. Have they ruled out IBD? I have a kitty with IBD and those are exactly her symptoms. I know Metronidazole has helped her, along with a novel protein, limited ingredient diet. She also seemed to do better when I was giving her a little pumpkin mixed into her food. She also gets digestive enzymes and probiotics, I don't know if they actually help but I like to think so. She has flare-ups (she's having one now) and she'll get tired of the food and refuse to eat it after a while, so we look for another food she can eat; poor baby is only just a year old, I don't know what we'll do when she has run out of food choices. :(
 
That's a very good question Lucy, and I guess the answer is that I honestly don't know if they have ruled it out entirely, or just shifted their focus based on this test result. I need to ask that tomorrow. Excuse my ignorance, but is there an actual definitive test for IBD, or is it diagnosed just based on a positive reaction to the Metronidazole, food change, enzymes and probioitics? How was your civie diagnosed?

We did use Metronidazole (aka Flagyl) for weeks with zero change, and a probiotic for about half that time. I asked about adding pumpkin, but at the time they weren't sure if it was bacteria overgrowth and/or parasites, and didn't want to add that until we knew for sure. I will ask about that again now too since we have ruled both out. I still have some in the freezer after unsuccessfully trying it with our previous sugar cat Brady (GA). I might thaw a chunk overnight and try it with Whisper in the morning to see if he wrinkles his nose at it. Since he has never turned down any food, and I mean ANY FOOD (thank goodness). Oh, and I just realized that your sugar cat and your IBD cat are different cats [I edited original reply]. I thought 1 year was awful young for diabetes. Poor kiddo.

As I said, food isn't an issue with my boy. If he lays on your arm for too long, I am pretty sure that he would start to nibble on it, but that is probably due to his unregulated diabetes (we are trying...just a lot going on in the first two months with him in our lives, including an insulin change). Knowing your baby's experience is very helpful. I am pretty sure that the vet mentioned digestive enzymes today too, but my mind was racing at the time just because I felt unprepared. I am not afraid, just unprepared, hence this post. Does anyone else know whether there is overlap in the treatment of both IBD and pancreatitis? I know that the steroids that likely (or is it always?) come with pancreatitis treatment worry me with regard to his diabetes, but you have to do what you have to do. I have seen IBD in many of your signatures, so if that is in fact where we end up, I may come calling for more help.

Thanks for your time, Lucy (and Squallie)!
 
Diarrhea/soft feces, particularly if paste colored or pale, that can be a sign of exocrine pancreatic insufficiency, or lack of pancreatic enzymes. The blood test for that needs to be done in a fasting state.
The treatment is to supply additional pancreatic enzymes to help the food break down.
 
I will see if that was a part of this same fasting GI blood panel and also do some googling to see pictures, but I don't think that I would explain it like that.

Sorry for the visual, but the color and consistency looks exactly like a melted Hershey bar. Uniform in color and texture, no blood or mucus, no lumps. Just a brown puddle.

Thanks!
 
Thanks Larry. The ultrasound couldn't definitely confirm pancreatitis, and I think that the Idexx Test is the same one that we had sent to Texas A&M (I think it was a collaborative development effort between the two if I read correctly).

Still haven't heard anything from either vet yet today, but hopefully we will soon.
 
Hi Sandy, I am sorry you're going through this with Whisper, but I am so glad you had the testing and bloodwork done. My beloved girl Tiger had an acute attack of pancreatitis, it is a horrible disease, which she recovered from luckily but only after a scary ER stay! I feel it created so many other problems for her, which were revealed by her ultrasound and IBD/lymphoma was a part of that picture. From reading your post, it sounds like your Whisper had thickening of the bowels, that usually means inflammation? Was there anything in his bloodwork, i.e. high neutrophils, esonophils? Here is a link to some info on IBD, if you have already seen any of this, my apologies: http://www.2ndchance.info/inflambowelcat.htm

I highly recommend you join the Feline IBD Kitties Support Group- on Facebook; here's a link if you are interested: IBD Kitties. There is a lot of experience and information on this site. There is also a support group for Feline Pancreatitis that may be helpful for you: https://groups.yahoo.com/neo/groups/Feline_Pancreatitis_Support/info

I hope you hear from your vets and get some definitive answers soon.
 
I am hesitant to even tell you our story because I really don't want to stress you out or scare you, but in case it helps somehow, I'll give you a short version. Speckles had diarrhea for about a month and a half. It would only improve in response to canned w/d, which I wasn't happy about feeding him, and eventually we got metronidazole too, which also helped. During this time, his poo was liquid, unless he was eating the w/d exclusively, and he tested positive for pancreatitis. The ultrasound we did at his regular vet showed that he had an inflamed pancreas (consistent with severe pancreatitis), and we treated him for a week and a half as if he had severe acute pancreatitis, because of that and the specific fPL test coming back positive. He had to be syringe fed for last week or so, and the meds didn't seem to be helping much. He really wasn't dehydrated til he'd had diarrhea for like 5 weeks and then it was almost impossible to keep him hydrated enough, even using subQ fluids daily. The day we had to let him go, we got some more imaging and found that it was definitely cancer (probably pancreatic).

I think the likelihood of your kitty having IBD or GI lymphoma should be discussed in detail with the specialist. Hopefully, it's neither, but it's better to be sure. I've gone over what happened to us a million times in my head, and I feel like even if we'd known what Speckles really had earlier, I wouldn't have let him go more than a day or two before we did because it really seemed like he wasn't ready to go yet. But I guess if I had known, I wouldn't have been expecting him to improve up til the very last minute, which was really hard to deal with after I found out that it had been cancer all along. I don't know if any of this info is useful, but...

Anyway, sending healing vines and positive thoughts for your adorable boy! He looks like a sweet kitty.
 
I am so sorry that you are having this issue with Whisper and hope they get to the bottom of it ( no pun intended) With all the dental stuff, and antibiotics, my guess is that his good bacteria flora is out of whack. Have you tried digestive enzymes with probiotics? I use NaturVet and get it from Chewy.com. It goes in all my pets food each meal. It seems to help all of the animals, dog had a long bout with pale pudding poop and 800 bucks later, the blood work the ultrasound, it was deemed "gastritis" the ultrasound showed a thickening in the stomach lining. Change her diet, give her pumpkin every meal and started on the NaturVet and she is all better. My Bubba used to go from diarrhea, to being normal, to constipation.....which is all part of the IBD syndrome and he has been helped with the NaturVet as well. He gets the pumpkin too and was doing great until right before this surgery and now he hasn't gone since the day before yesterday. Anyway, thought I would share that and maybe it could help Whisper. Keeping good thoughts for y'all!~
 
Thanks all. I had to pull away from the internet for a little bit today because I was starting to make myself frantic. Our regular vet called this evening and was very apologetic, but said that she still hasn't heard from the IM even though she has been trying. :-(

I will definitely look into the IBD and pancreatitis groups tomorrow, and I am going to get copies of all of our tests so far so that I know exactly what each showed. I am sure that I have heard it all from them directly at the time, but everything is starting to run together.

We had tried Fortiflora, but the NaturVet with the addition of the enzymes sounds different and more powerful and I will look at that as well. And Speckles parent, no worries, my very first kitty died at the age of 8 after a ten-hour surgery to remove a huge thymoma from his chest, for which the only outward symptom was diarrhea. It is constantly in the back of my mind and might be what is worrying me the most.

Thank you all.
 
Sandi, no advice or thoughts on Whisper's condition, just a hearty "wow" - he is such a cutie and you are amazing for taking him in and giving him a chance. I wish you all the luck there is in getting him well. You are awesome.
 
That is sweet of you to take the time to say, Melanie, but we are lucky to have him in our family. I am just a little heartbroken that I don't yet feel like we "rescued" him, but I am trying to be hopeful that it will turn around soon. And I can't believe how much I already love him even though it has only been two months

Genghis is adorable, looks just like my first baby JT. What soulful eyes!
 
Sandi & Whisper said:
Thanks all. I had to pull away from the internet for a little bit today because I was starting to make myself frantic. Our regular vet called this evening and was very apologetic, but said that she still hasn't heard from the IM even though she has been trying. :-(

I will definitely look into the IBD and pancreatitis groups tomorrow, and I am going to get copies of all of our tests so far so that I know exactly what each showed. I am sure that I have heard it all from them directly at the time, but everything is starting to run together.

We had tried Fortiflora, but the NaturVet with the addition of the enzymes sounds different and more powerful and I will look at that as well. And Speckles parent, no worries, my very first kitty died at the age of 8 after a ten-hour surgery to remove a huge thymoma from his chest, for which the only outward symptom was diarrhea. It is constantly in the back of my mind and might be what is worrying me the most.

Thank you all.
Click to expand...
We have our fingers and paws crossed that it's nothing serious. Please keep us updated! He's a cutie.
 
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