Managing BAD pancreatitis- Anything else I can do??

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SpecklesandMe

SpecklesandMe

Member Since 2015
Hi all,
Here is the old thread: http://www.felinediabetes.com/FDMB/threads/hemorrhagic-pancreatitis-pain-med-question.142373/ (Not sure how to officially link it- so hoping that work.)
The short version is that after about a month of diarrhea that could only be controlled by W/D canned food, my kitty became dehydrated despite my best efforts to put Pedialyte and water into his food. Then last Wed-ish, he started acting very sick, not eating much, and by Thurs night I had to coax food into him. We got specfPLI back >51. He started retaining fluid around last Wed and we had to have ascites drained today. The sample of the fluid sent out on Fri was negative for cancer. The vet sent out a much larger sample today to double check b/c on the ultrasound, they saw "bright spots" on the abdominal lining. The vet said this could be due to severe pancreatitis or something worse. Should get cytology from the fluids back tom or Wed. I don't know how he declined so fast after we were managing the diarrhea as much as possible for a month. I am very, very worried.

He is on the fentanyl patch for pain. We had mirtazapine, but he was not able to sleep for 2 days on it, so I just started cypro today, along with pancreatic enzyme tablets, ondans for nausea, and Pepcid or Cerenia as needed. We syringe fed through the weekend and today (were told he would not tolerate a feeding tube well). We are also doing subQ at home as needed. I am being told that even if the cytology is negative for cancer again, that I should consider his quality of life if he does not improve in a few more days. The vet acted like a pancreatitis flare should only last for 2 weeks and he tested positive for it a week and two days ago. They thought the ascites was a bad sign, but I saw on his bloodwork that he has slightly low albumin and I read that this can result in ascites during pancreatitis. I really, really want to do everything possible to save him. He was fine other than the diarrhea, which was relatively controlled, less than a week ago- so this is really sudden. I would really appreciate any advice/tips.

And if anyone has used cypro a lot, can you give me a sense of how long it takes to kick in? Not sure when to offer food after giving it...

Thank you!
 
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@Critter Mom knows a lot about pancreatitis...she may be able to help. Not sure she is online at the moment though.
Do you need a second opinion.? Sounds like your vet is giving up.
I'm with you ....try and save him if possible....hopefully the second cytology is OK too.
My cat had diarrhoea for months a couple of years ago and it turned out to be an allergy to the food. I now feed raw and she is fine. She is prone to pancreatitis as well, and is treated with antibiotics, pain meds and fluids when she gets a flare up.
Critter mom knows far more than me about it all. Hopefully will answer soon.
Good luck with it all
 
I can't answer your cypro question as we never used it but wanted to send you big huge hugs. Are the the pancreatic enzymes 'digestive' enzymes? If so, if I gave KT much of that, it made his stomach really hurt. When I hit the right dose, they helped so much.

Any idea why vet said he wouldn't do well with a feeding tube? We never progressed that far, he'd accept syringe feeding patiently.

Tagging @Marje and Gracie for you as she wrote the primer on pancreatitis you'll find in the forum stickies.

More hugs, there's lots of experience here - someone will stop by soon...
 
Bron and Sheba said:
she may be able to help. Not sure she is online at the moment though.
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Thanks, Bron!
Mogs has been with us every step of the way, and it's thanks to her that I got my kitty the new meds today. I know she has her own stuff to deal with right now- so I was just trying to get more eyes on this.
And thank you for the encouragement. He is so important to me, and I don't want to make the wrong decisions for him. Please keep your fingers crossed for us.
 
Squeaky and KT said:
Are the the pancreatic enzymes 'digestive' enzymes? If so, if I gave KT much of that, it made his stomach really hurt. When I hit the right dose, they helped so much.
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Yes, it's the pancreatic digestive enzymes. What was the right dose for KT (if you remember)? I'm not sure how to calculate the dose based on weight. They told us to do .5 of the tablets 2x per day. We've never used them before.
The feeding tube thing was based on them thinking he may not make it through the process in his current state, plus his personality of being independent and feisty to the vet. They were worried that he seemed so mellow, but he is sick and on strong meds... so I don't know how to judge how much is from which of those issues.
Thanks for the useful info and hugs! And for tagging!
 
Mine are in large capsules that I broke open rather than tablets that you have. I'd follow their instructions but watch if you see what looks like he's uncomfortable. It's going to be hard to tell since he's already in pain from the pancreatitis and on pain meds. KT had them quite often as he also had EPI so had to have something to help with digestion.
 
There are pancreatic enzymes and digestive enzymes and they are different. Usually, the pancreatic enzymes are like Pancreved, Pancrezyme, Viokase. They are usually extremely expensive and you would not want to give them for pancreatitis. They are usually for exocrine pancreatic insufficiency which causes malabsorption and the cat can starve to death even if it is eating.

Digestive enzymes are different and that may be what your vet is having you give.

The only thing I would add for you to check on is something for pain like buprenorphine. pancreatitis can be very, very painful.

Sending your sweet baby healing vines. And, btw, I've seen csts with elevated specfPL for a very long time. The kitty may wane in and out of pancreatitis but often the numbers stay up.
 
SpecklesandMe said:
We had mirtazapine, but he was not able to sleep for 2 days on it, so I just started cypro today,
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Bonnie was very hyper and wouldn't stop meowing on Mirtazapine. A lot of cats here seem to do well on Cypro.

CJ was on pancreatin for diarrhea for awhile. She had no symptoms associated with acute or chronic pancreatitis. She never had pain or trouble eating.

Sending you and Speckles lots of healing vines.
 
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Pancreatabs are a pancreatic enzyme. I would ask the vet whether he/she thinks Soeckles has exocrine pancreatic insufficiency. While it is not common in cats, it does occur.
 
Hi @SpecklesandMe, sending you very big hugs. My cat Kismet was newly diagnosed a fortnight ago with Diabetes, but suffered a terrible Pancreatic attack which lasted 3 days around the same time just as she was starting her insulin. It was terribly stressful, so my heart goes out to you.

I'm not an expert, but managed to nurse Kiz through it (she's was rehydrated on a drip at the vets, but was given no other meds except an antibiotic and she still had three days of not eating in total). I used a few tips I found on Tanya's CKD website:

Slippery Elm powder mixed with water into a gel and syringed into her mouth in small amounts slowly, approx every half hour (this coats the stomach lining to help combat the acid/nausea). You can get it from health food shops, or possibly from a chemist.

Apparently Kitties won't eat anything they associate with making them feel nausea, and the nausea is caused by the stomach producing too much acid (particular problem when it's empty), so offer a different food, preferably low carb one that has no cereals (in case of allergy/intolerance). Another tip from Tanya's CKD is using tinned Tuna in Spring Water. Although tuna on its own isn't a great food for long-term, short term it can help get something down them to help `line' the stomach and so help get rid of the acidity.

A couple of other things I did were based purely on my knowledge of natural human anti-acids and were done out of sheer desperation. I used a tablespoon of Apple Cider Vinegar in a cup of water with an 8th of a teaspoon of Bicarbonate of Soda and used a flannel to apply a bit of it to her paws. She licked it off and that in conjunction with the other methods it seemed to calm her stomach.

These seemed to get Kismet through a very long and bad attack and were all easily accessible. It's well worth a visit to Tanya's CKD website as there's a lot about treating feline nausea/stomach acid on there. Keeping my fingers and toes crossed for both of you xxx
 
Two more thing that are typically used to help with pancreatitis issues that I didn't see your vet utilizing are:

Metronidazole to stop the diarrhea

Famotidine for stomach acid

Squeaker has pancreatitis every six months and the highest his Spec fPLI has been is 36 but treatment is always the same. Sub-q, nausea control, acid control, pain control if needed and B12 injections are also of special benefit during pancreatitis. Might want to ask your vet about getting these, every day wouldn't hurt right now. Vet can also give famotidine and Cerenia injections for a couple of days to get nausea and acid under control then switch over to the oral meds.
 
Anitafrnhamer said:
Two more thing that are typically used to help with pancreatitis issues that I didn't see your vet utilizing are:

Metronidazole to stop the diarrhea

Famotidine for stomach acid

Squeaker has pancreatitis every six months and the highest his Spec fPLI has been is 36 but treatment is always the same. Sub-q, nausea control, acid control, pain control if needed and B12 injections are also of special benefit during pancreatitis. Might want to ask your vet about getting these, every day wouldn't hurt right now. Vet can also give famotidine and Cerenia injections for a couple of days to get nausea and acid under control then switch over to the oral meds.
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Great idea. I wonder if he can let me bring the injections home to do. The oral might not be working great for him. (I added famotidine without the vet telling me to b/c I saw people on here using it.)
They ran a fecal PCR and it was negative for everything. He'd just been on Zenequin- so they didn't think antibiotics would help.
Will the pancr enzymes stop the diarrhea? Not sure what to expect...
 
[QUOTE="
Will the pancr enzymes stop the diarrhea? Not sure what to expect...[/QUOTE]

I doubt it. Metronidazole is really the best thing to use. You will notice a difference after two or three doses (it's typically given every 12 hours). If you have a cooperative vet he should be able to give you the B12 to use at home.
 
another thing you can ask for with diarrhea is prescription clay. the vet should have it.
I used several things for severediarrhea becausethe metronidazole wasn't quick.... it takes days to kick in.

I had cerenia in oral liquid because the shots hurt....the vet said so and so did Shadow.

and I put the clay in capsules because mine wouldn't eat her food with meds of any kind.
 
SpecklesandMe said:
Did it help? If so, do you remember how quickly?
I don't know what to expect the poo to look like if it starts working. He had yellowish diarrhea again last night. :(
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Yes, it helped tremendously. Antibiotics were given initially with the Pancreatin. It took some time before the diarrhea cleared up a few weeks or so after the antibiotics ran its course. I also gave her Forti Flora probiotics (mixed in food and forced fed) while she was on antibiotics. After a few months I was able to reduce the Pancreatin and then stop it completely. It came back in full force when she was diagnosed with diabetes. Once she went OTJ and on a low-carb canned diet, the diarrhea was resolved and she hasn't had a need for Pancreatin. Now, when she has soft stools, I am able to manage it with Forti Flora.

You would see normal brown stools if it works. If the stools are loose, you'd want to increase dose with your vet's guidance.

CJ tested positive on the fecal enzyme test so I am guessing she had EPI.

I wish this was all you had to deal with.. Lots of healing vines for you and Speckles.
 
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SpecklesandMe said:
Hi all,
Here is the old thread: http://www.felinediabetes.com/FDMB/threads/hemorrhagic-pancreatitis-pain-med-question.142373/ (Not sure how to officially link it- so hoping that work.)
The short version is that after about a month of diarrhea that could only be controlled by W/D canned food, my kitty became dehydrated despite my best efforts to put Pedialyte and water into his food. Then last Wed-ish, he started acting very sick, not eating much, and by Thurs night I had to coax food into him. We got specfPLI back >51. He started retaining fluid around last Wed and we had to have ascites drained today. The sample of the fluid sent out on Fri was negative for cancer. The vet sent out a much larger sample today to double check b/c on the ultrasound, they saw "bright spots" on the abdominal lining. The vet said this could be due to severe pancreatitis or something worse. Should get cytology from the fluids back tom or Wed. I don't know how he declined so fast after we were managing the diarrhea as much as possible for a month. I am very, very worried.

He is on the fentanyl patch for pain. We had mirtazapine, but he was not able to sleep for 2 days on it, so I just started cypro today, along with pancreatic enzyme tablets, ondans for nausea, and Pepcid or Cerenia as needed. We syringe fed through the weekend and today (were told he would not tolerate a feeding tube well). We are also doing subQ at home as needed. I am being told that even if the cytology is negative for cancer again, that I should consider his quality of life if he does not improve in a few more days. The vet acted like a pancreatitis flare should only last for 2 weeks and he tested positive for it a week and two days ago. They thought the ascites was a bad sign, but I saw on his bloodwork that he has slightly low albumin and I read that this can result in ascites during pancreatitis. I really, really want to do everything possible to save him. He was fine other than the diarrhea, which was relatively controlled, less than a week ago- so this is really sudden. I would really appreciate any advice/tips.

And if anyone has used cypro a lot, can you give me a sense of how long it takes to kick in? Not sure when to offer food after giving it...

Thank you!
Click to expand...

I only just read this now - so sorry Speckles is having so much trouble. I have no advice, just a hug and I hope he feels better soon.
 
Anitafrnhamer said:
Metronidazole is really the best thing to use
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Picking up metronidazole in the morning (they said it was okay to use with the cypro, Pepcid, ondans, cerenia, and panc enzymes- if anyone knows any differently, pls let me know). B12 shot will happen in the morning. Thank you!
We are also doing subQ fluids 1x per day (or 2x if he feels dehydrated).

I hate diarrhea. I feel so bad b/c he gets it on himself and then isn't feeling well enough to clean it, but hates when we try to clean it. I have a feeling this is what is sometimes called "acute in chronic" pancreatitis. I think it started as chronic and then got way worse last week. Please keep your fingers/paws crossed for us.

And thank you to everyone for the healing vines and the helpful advice!
 
SpecklesandMe said:
Picking up metronidazole in the morning (they said it was okay to use with the cypro, Pepcid, ondans, cerenia, and panc enzymes- if anyone knows any differently, pls let me know). B12 shot will happen in the morning. Thank you!
We are also doing subQ fluids 1x per day (or 2x if he feels dehydrated).

I hate diarrhea. I feel so bad b/c he gets it on himself and then isn't feeling well enough to clean it, but hates when we try to clean it. I have a feeling this is what is sometimes called "acute in chronic" pancreatitis. I think it started as chronic and then got way worse last week. Please keep your fingers/paws crossed for us.

And thank you to everyone for the healing vines and the helpful advice!
Click to expand...

The vet has given metronidazole when diarrhea has been severe and it has helped faster than the enzyme. I can relate to the frustration of cleaning up the diarrhea. It is awful when it is everywhere and non-stop. B12 shots should help too.

Keeping fingers and paws crossed.
 
Quick update: The second set of big samples they sent out for cytology were negative for cancer. (Sigh of relief!) I am so grateful for that, but need to stay focused because the acute pancreatitis is still pretty severe.
 
The ondans worked really well for the first few days, but he's gagging again as of yesterday/today. I tried rantiidine thinking maybe the Pepcid had stopped working for him. It didn't seem to make a huge difference. Any thoughts on whether I should try to get ahold of injectable ranitidine or famotidine, or if I should just go ahead and try a proton-pump inhibitor? Anyone used omeprazole before?
He has been trying to drink water on his own, which is something I haven't seen him do since Fri. Prob the vet would say it's because of how bad the stomach acid has gotten, but I am hoping it's actually because he might be rallying.
 
Omeprazole is stronger / better for humans than famotidine. If your vet said omeprazole is okay for cats, then I'd give it a try. I don't know what the dose is.

So glad the result was negative for cancer. Keeping paws crossed that the pancreatitis gets under control soon.
 
Ondans/cerenia are not working for nausea any more. We started Carafate and Prilosec this morning. He still gags a lot.
Cypro/mirtazapine are not working for appeptite. Still syringe feeding.
I am getting very worried. It's been 8 days since this severe bout started. He is walking around more but that might also be the fentanyl patch wearing off.
Three questions:
1. Should I start considering a steroid?
2. What are the things I need to be particularly cognizant about with using a steroid on a diabetic cat?
3. One of the vets suggested metacam b/c it's an anti-inflammatory, but I think if I were going to take that risk, I may as well try a steroid. Thoughts?
 
Yes, I would definitely consider a steroid. You may have to increase the dose of Lantus based on if his BG goes up. I don't know enough about metacam to comment, sorry.

Marshmallow's nausea is also really bad and the ondans/cerenia/pepcid aren't working. What dose of prilosec are you giving? Are you giving OTC prilosec? I think I need to try it for Marshmallow. She gags even when I'm syringe feeding her and I'm not getting enough food into her.
 
granadilla said:
Yes, I would definitely consider a steroid. You may have to increase the dose of Lantus based on if his BG goes up. I don't know enough about metacam to comment, sorry.

Marshmallow's nausea is also really bad and the ondans/cerenia/pepcid aren't working. What dose of prilosec are you giving? Are you giving OTC prilosec? I think I need to try it for Marshmallow. She gags even when I'm syringe feeding her and I'm not getting enough food into her.
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1/4 of the 20mg tablet 1x per day 30min before food. More info here: http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#omeprazole I liked the idea of getting a capsule and counting out the beads to put in his food, but the Walgreens capsules now have a solid tablet in the middle of the beads- so you can't use it like that anymore. Hope it helps Marshmallow. Apparently could take a few days to work.
EDIT: Yes, it's non-prescription (20mg strength).
 
Does anyone know how long does bup pain med last if i have it in the fridge? would it still be good after 5 yrs???
 
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