? Not Shorshe, Need help with my Cat with Chronic Pancreatitis with v frequest Flares

S

Shorshe’s Mum

Member
One of my other cats Kaju, who has just turned 12 has been dealing with pancreatitis flares for about 2 years now and the flares are getting closer and closer and he has not been his usual self since October last year. I am pasting his medical history and tests tabulated in an exel. I really need some help understanding what's happening--I am constantly feeling guilty given I have to divide my time between four cats including one with diabetes and another with CKD and I feel I am not able to provide him with the care he needs or grasp fully what is causing these flares. His flares increasingly seem to involve the pancreas, liver and small intestine. (have attached the exel below with his ultra sound reports and bloodwork)

FYI: I am syringe feeding him the wet food z/d because he refuses to eat any wet food. And I don't want him on just dry food. Also, if he doesn't eat every 4-5 hours he starts vomiting and there's no guarantee that he will eat even with a timed feeder if I leave dry food. The only time I leave him dry food is at night when I can;t wake up every 4-5 hours. If anybody has any suggestion about this that would reduce the syringe feeding I would be so grateful: I am single person taking care of them and my full time job sometimes takes me away for short periods. The last two episodes of flare ups have happened when I was away. And his only instance of diarrhea (usually his flare ups are characterised by acute vomiting) was when he was boarded ath the veterinary hospital. They have largish rooms--about 50-100 square feet--and vet nurses wh can syringe feed and administer medicines as well as 24*7 vets available on call. However, I think he gets stressed even with gabapentin and that triggered his diarrhoea and weight loss when he was there last July-August while I was in India taking care of Shorshe.

As for low carb diets: Thailand has a lot of tuna and fish based complimentary (eg: applaws, pramy, vif, felina canino, sheba) and one or two varieties of complete low carb (nekko gold: i think the same brand produces churu: inaba) wet food. Kaju won't eat them and even after putting Shorshe (diabetic) and another cat [Kalonji] with sensitive stomach and some hyperechoic parenchyma on the ultrasound image of pancreas, on them they vomit frequently. Maybe it's guar gum or tapioca starch. Bottom line, good quality low carn food is not availble or is imported and prohibitively expensive. I cannot afford ziwi peak or even facy feast (the latter costs almost as much as a can of prescription diet food for less than half the amount of food and the former costs 2 times a can of prescription diet cans).

Medical History: https://docs.google.com/document/d/1T_czmUEq6MV4LrMB4IowyAvCGrDURNARbtEGWkw_TvA/edit?tab=t.0

Tests Exel:
https://docs.google.com/spreadsheets/d/1iGcKrl3ga0wtICzWKaqkVvPK8B7BOnFu6D3h0-OjBfw/edit?usp=sharing
 
Madhura/Maddie said:
One of my other cats Kaju, who has just turned 12 has been dealing with pancreatitis flares for about 2 years now and the flares are getting closer and closer and he has not been his usual self since October last year. I am pasting his medical history and tests tabulated in an exel. I really need some help understanding what's happening--I am constantly feeling guilty given I have to divide my time between four cats including one with diabetes and another with CKD and I feel I am not able to provide him with the care he needs or grasp fully what is causing these flares. His flares increasingly seem to involve the pancreas, liver and small intestine. (have attached the exel below with his ultra sound reports and bloodwork)

FYI: I am syringe feeding him the wet food z/d because he refuses to eat any wet food. And I don't want him on just dry food. Also, if he doesn't eat every 4-5 hours he starts vomiting and there's no guarantee that he will eat even with a timed feeder if I leave dry food. The only time I leave him dry food is at night when I can;t wake up every 4-5 hours. If anybody has any suggestion about this that would reduce the syringe feeding I would be so grateful: I am single person taking care of them and my full time job sometimes takes me away for short periods. The last two episodes of flare ups have happened when I was away. And his only instance of diarrhea (usually his flare ups are characterised by acute vomiting) was when he was boarded ath the veterinary hospital. They have largish rooms--about 50-100 square feet--and vet nurses wh can syringe feed and administer medicines as well as 24*7 vets available on call. However, I think he gets stressed even with gabapentin and that triggered his diarrhoea and weight loss when he was there last July-August while I was in India taking care of Shorshe.

As for low carb diets: Thailand has a lot of tuna and fish based complimentary (eg: applaws, pramy, vif, felina canino, sheba) and one or two varieties of complete low carb (nekko gold: i think the same brand produces churu: inaba) wet food. Kaju won't eat them and even after putting Shorshe (diabetic) and another cat [Kalonji] with sensitive stomach and some hyperechoic parenchyma on the ultrasound image of pancreas, on them they vomit frequently. Maybe it's guar gum or tapioca starch. Bottom line, good quality low carn food is not availble or is imported and prohibitively expensive. I cannot afford ziwi peak or even facy feast (the latter costs almost as much as a can of prescription diet food for less than half the amount of food and the former costs 2 times a can of prescription diet cans).

Medical History: https://docs.google.com/document/d/1T_czmUEq6MV4LrMB4IowyAvCGrDURNARbtEGWkw_TvA/edit?tab=t.0

Tests Exel:
https://docs.google.com/spreadsheets/d/1iGcKrl3ga0wtICzWKaqkVvPK8B7BOnFu6D3h0-OjBfw/edit?usp=sharing
Click to expand...
@Sienne and Gabby (GA)
@Bron and Sheba (GA)
@Diane Tyler's Mom GA
 
Max had chronic pancreatitis. Not eating suggests nausea. I had to give him ondansetron for months at a time. ZD is not a great food. Have you tried fancy feast? With bad flares I would try ondansetron every 8 hours. If vomiting cerenia every 24 hours should help. Once nausea meds are started you could add an appetite stimulant. I like cyproheptadine but vets have a gel you put in the ear you could get. Have you read any if the files in our pancreatitis handbook? There’s also a good forum on groupsio for pancreatitis.

Here’s a link to our information on pancreatitis. Good luck. I think pancreatitis may have helped cause Max to become diabetic but that’s just my theory.
https://felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.79693/
 
Kaju's present weight is about 6.2 KG
Currently Kaju's meds:

1. Gabapentin 25 mg once a day for pain (we tried tramadol but he was very anxious/agitated)
2. Ondansetron 2mg twice daily (for nausea. Cerenia injection was given for 4 days. unfortunately cerenia tablets are not available and the vet said not to use the injections more than 5 days in a row)
3. Samylin medium 1 tablet once a day
4. Ursodiol 1/3rd of 250mg capsule onec a day
5. Prednisolone at 0.1mg/kg once a day
6. Ringers acetatte fluids 200 ml on alternate days (sub cutaneously)
7. Cisepride twice a day

I am very reluctant to change Kaju's food quickly because since being on this food since late october (z/d) his acute vomitting has drastically reduced. Also as I said above, I cannot afford the imported food like fancy feast as tey are prohibitively expensive and besides he won't eat any wet food. I do not want to trigger food aversion and stress right now with him.

i am trying to understand what I am doing wrong? What is triggering these flares, especially as they involve his intestine (you can see his USGs from the last year or so show thickening of small intestine with recent ones showing involvement of both jejunum and ilium as well as inflammation of the mesenteric lymph node) and liver (he keeps having high ALT, including just recently over 800 and now for the first time high GGT). The RVC podcast on distinguishing IBD from small cell lymphoma says biopsies are necessary but the internal medicine vet here feels it's too invasive and carries risks.

Is it his pancreas that is leading to the inflammation of the liver and intestine? The vets here feel that is the case. But would love to hear from people who dealt with pancreatic "flares" and how you guys managed. I am not dealing with this too well. He's my youngest and usually talkative and goofy and it's hard seeing his personality change and feeling like I am not being able to help him and not being able to amange his condition adequately.
 
Food is not often the cause of flares except for perhaps a very high fat diet. Max did not have intestinal thickening.. Sounds like with your cat it’s not only pancreatitis I don’t know what caused them with Max but every time he had a vet checkup and was seeming fine a flare would occur.

It’s true that you need a biopsy to distinguish IBD from scl. Depending on where the thickness is sometimes an endoscopy will work. With one if my current cats the endoscopy did not give a result. She could eat anything but I had recently switched to lamb and beef so I could feed both cats the same. I eliminated those two foods. She was on prednisolone for several months and gradually weaned off. You don’t want to use prednisolone if considering a biopsy because then the biopsy won’t show results.

With IBD a food elimination diet would be a good idea. You would need to switch to a protein never eaten before and only that protein for at least a month.
 
tiffmaxee said:
Food is not often the cause of flares except for perhaps a very high fat diet. Max did not have intestinal thickening.. Sounds like with your cat it’s not only pancreatitis I don’t know what caused them with Max but every time he had a vet checkup and was seeming fine a flare would occur.

It’s true that you need a biopsy to distinguish IBD from scl. Depending on where the thickness is sometimes an endoscopy will work. With one if my current cats the endoscopy did not give a result. She could eat anything but I had recently switched to lamb and beef so I could feed both cats the same. I eliminated those two foods. She was on prednisolone for several months and gradually weaned off. You don’t want to use prednisolone if considering a biopsy because then the biopsy won’t show results.

With IBD a food elimination diet would be a good idea. You would need to switch to a protein never eaten before and only that protein for at least a month.
Click to expand...
@Bron and Sheba (GA)
 
Thanks everyone for the advice. He seems to be eating a bit more on his own after increasing teh ondansetropn dosage.
I have ordered a single protein venison food (ziwiw peak air dried) to see if he improves on that. Also, Dr Elsey's is available here. I sit worth it to try him on the rabbit and chicken one? Additionally, I should be able to get Young Again LID Zero mature but it seems to have chicken as well as hydrolised pork. I have to order it from Singapore which works out very expensive so wondering if anyone has actually trialed it for an IBD cat/would recommend it?
 
Diet often does not have an effect on pancreatitis in cats but some cats do better if not on a high fat diet. None of my cats had diet issues. Max seemed to be triggered by stress such as vet visits. So I can’t answer your question. I suggest joining the groupsio pancreatitis forum. I’d consider a raw diet but I know they dint like them and until a test to check for bird flu I would not suggest that switch. What about making your own cooked food and use a good supplement?
 
tiffmaxee said:
Diet often does not have an effect on pancreatitis in cats but some cats do better if not on a high fat diet. None of my cats had diet issues. Max seemed to be triggered by stress such as vet visits. So I can’t answer your question. I suggest joining the groupsio pancreatitis forum. I’d consider a raw diet but I know they dint like them and until a test to check for bird flu I would not suggest that switch. What about making your own cooked food and use a good supplement?
Click to expand...

I have tried cooking food, he won't eat it. And I cannot afford him not eating as it triggers days of vomitting. And I cannot give him raw food in Thailand--meat is very unhygenically handled and I wouldn't trust any raw food (also I doubt he will eat it). Plus, since he had suspected SIBO (high folate levels) I wouldn't want him to have any raw food.

I am on the pancreatitis group, just not sure if it's the pancreatitis triggering the small intestine or the other way around.
 
Don't have much to offer for the actual pancreatitis problems, but regarding the pain meds--Our very old cat was put on gabapentin for pain from his severe arthritis. Vet had us do one dose a day, but after a bit it clearly wasn't doing enough. Vet said we could add a second dose in the evening, but it really sedated the cat. So we then tried only a half dose in the evening at dinner, with a full dose at breakfast. Results were not obviously great.
THEN, we got the idea to stick to the same amount as one and a half doses, but to split it evenly, so now our cat gets .75 dose of gabapentin at both breakfast and dinner. The first two days looked a little rough, but once his old body got used to this more constant level of gaba, he is doing much better! He is clearly in less pain, and less sedated/dopey/wobbly than he was on even just the single dose in the morning. So, maybe talk to your vet about splitting the gabapentin into two even doses over the day? The lower single doses, but more constant level of gabapentin has made a world of difference for us. If your cat is in less pain, perhaps he might be more willing to eat a little on his own?

Just the one little idea I can offer you. We had a kitten go through pancreatitis at 8 months old, it was so scary as he almost died, and so distressing to see how sick he was and the pain he was in, our vet had given us just 2 days of gaba for him, when on the gaba he perked up and would let us feed him, when it wore off he was just limp and nearly lifeless. We had to argue and convince our vet to give him more pain med for more days, then again he would eat when he felt better because of the pain med, and we were able to get him through it.

(Our cat is 18+ years old, weighs about 4.7kg, and now gets 0.75mL of 50mg/mL gabapentin twice a day, for a total of 75mg gabapentin daily.)
 
Gracie85 said:
(Our cat is 18+ years old, weighs about 4.7kg, and now gets 0.75mL of 50mg/mL gabapentin twice a day, for a total of 75mg gabapentin daily.)
Click to expand...
My Nala, about 9 lbs, gets 50 mg gabapentin twice daily. I get human 100 mg capsules (come in $3 gelcaps) and divide ½ of that visually into another #3 gelcap and administer each gelcap via a pill gun. Gabapentin tastes terrible.
 
I can’t mail them if I do not have your address, the PM conversations are private only seen by whom you send it to
 
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