Hi Gary,
Sorry I haven't visited your thread in a while. It's great that you've now got a vet you feel more comfortable with but I'm really very sorry to hear that Tom has pancreatitis. My cat, Saoirse, has chronic pancreatitis. Below I have given details of things that helped her through her major flare last year.
If Tom is finding it harder to eat it that is likely down to nausea and/or pain. Here's the
nausea symptom checker from Tanya's Site that I found very helpful. There's a page on pancreatitis at that site, too.
First up, elevate Tom's food and water dishes so that he doesn't have to bend down to eat. (Stick a few paperback books or similar underneath them.) If he'll take some water mixed up with the food that will help with hydration. If not, you need to get vet input on how to keep him properly hydrated. You can check for hydration by pulling up the skin on the scruff of the neck: if it 'snaps' back into place then hydration is most likely OK; if it's slow to return to normal then he may be dehydrated. Also you can check his gums. If they're slightly sticky that indicates dehydration, too.
Vet Meds & Supplements Checklist:
- generic ondansetron for nausea (Zofran, the branded version is crazy expensive) - a must-have. NB: for the UK the Bristol Laboratories generic ondansetron is recommended for cats by experienced caregivers. It's a human medicine so if your vet can't get the generic from their wholesaler (our vet couldn't) you should be able to get a written Rx and have it filled at Boots, Morrisons in-store pharmacies or other chemist. I pay less than £10 for 30 tablets.
- cyproheptadine for appetite stimulation (small doses can work better (e.g. 1/8 4mg tablet 2-3 times a day for 10lb cat) - larger doses can cause too much sedation and somewhat depressed mood) - also a must-have.
- famotidine or ranitidine for stomach acid (may not be needed but very good to have on hand). Famotidine only needs to be given once a day. Ranitidine needs to be given twice a day.
- Course of weekly VITAMIN B 12 injections - once a week for several weeks (check
IDEXX pancreatitis treatment guidelines for how many weeks initially and also maintenance) - another must-have.
- buprenorphine for pain relief. (Saoirse does better on small doses - <0.1ml for 10lb cat ad hoc, max 2x per day suited her at height of flare - higher doses disagreed with her in a big way and made her very lethargic, but every cat is different).
- Flagyl or Stomorgyl 2 for diarrhoea if present (antibiotics - both contain metronidazole). Our vet prescribed the Stomorgyl 2 for Saoirse because apparently it's not quite as foul-tasting as the Flagyl.
- Pro-Kolin for diarrhoea - kaolin paste with probiotic.
-
Nutramed (UK Only) - anti-inflammatory herbal supplement (boswellia, milk thistle, maritime pine bark).
- Liver support - check the IDEXX guidelines on supplementation with Denamarin or similar and discuss with your vet. The liver and pancreas are side by side and inflammation in the latter can irritate the liver also. (I give Saoirse Hepatosyl 50.)
Note: ondansetron and buprenorphine can cause a little
constipation.
I can't emphasise strongly enough how valuable it is to keep a stock of ondansetron and cyproheptadine at home from now on so that you can address any reappearance of nausea symptoms or lack of appetite straight away; it makes a huge difference.
Food and Water:
- Fluids (preferably through adding a little to each meal), else consult vet about alternative methods.
- Feed small, frequent meals - something highly digestible helps. I fed Saoirse chicken breast gently poached in water, minced finely and served with a 50-50 mix of the poaching broth and water. At the height of her flare last year I fed her 1 tbsp minced chicken with 1 tbsp water and 1 tbsp broth every hour, 24/7. Timed feeders are invaluable for dispensing food when you need to get some rest. Even if appetite improves, keeping to mini meals (not necessarily as frequently as 1 every hour) during the height of a flare puts less strain on the pancreas.* Gradually I managed to wean Saoirse onto
Liquivite liquid recovery food and that helped keep her hydrated as well as getting the full complement of nutrients she needed. It's a soupy consistency with a high moisture content (c. 90%) so it's suitable for syringe feeding and helps with hydration.
- Slightly warming food (c. 10 seconds at 20-40% in the microwave - stir and check for hot spots before serving it), or sprinkling it with crumbled up chicken Cosma Snackies or similar treats can make the food more tempting.
- Going forward, any changes to diet should be made cautiously; ideally only one slow change at a time.
- Some pancreatitis kitties are quite sensitive to the fat content of the food, but not all. For what it's worth, Saoirse is not overly fat-sensitive and after 9 months of food trials I finally found a food that she tolerates quite well. It's Sheba Fine Flakes in Jelly Poultry Selection. She also got on relatively OK with Smilla Kitten Food with Chicken (from zooplus.co.uk). Both are very low carb (<2% kilocalories from carbs) so if you're feeding a higher carb food, you should check with your vet and also make sure you're able to home test before making any food change (otherwise BG could go too low).
I strongly recommend you avoid feeding foods with carrageenan listed as an ingredient. It can inflame the GI tract. (I didn't know about the problems with carrageenan last year and I fed Saoirse a low carb food containing carrageenan and that triggered her major flare. It also upset my other cat's stomach.)
Hope some of the above helps or gives you some ideas to try for Tom. I truly hope he feels better soon. If there's anything else I might do to help in the meantime, just tag me. Pancreatitis is tough on both the cat and their person; it is a bit of a roller coaster but with the right supportive treatments and food it is manageable. Saoirse was very, very sick last year at the height of her flare, but she got a lot better once the treatments started working. The key is to keep Tom eating and getting enough fluids while the medicines help him. The Liquivite food worked a minor miracle for Saoirse. They do trial quantities of small numbers of cans.
Is Tom still being treated at the vets? Please send us an update when you can to let us know how you're both doing, Gary.
Mogs
(PS: I'm glad that you got past the PTSD stuff.
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* Lantus (insulin glargine) may be a better choice for a cat with pancreatitis because its gentler action profile can work better when a cat needs lots of small meals during the day to ease the strain on the pancreas. The UK drug cascade rules permit prescription of insulins other than Caninsulin if the Caninsulin doesn't work for the cat. Keep an eye on your forum Inbox (top right hand side of screen). I'm sending you a PM.
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I can also relate to 'life before' and 'life after'. I had an accident and I truly can't believe how different - how unrecognisable - my life is now as a consequence. 
Ha-ha! You're in good company here, Gary.
