Aw, Shannon.
It is very hard to see how poorly they get with the likes of pancreatitis. On the same page as you with the sleeping. I have PTSD so my sleeping is very disrupted at the best of times but it was definitely worse when Saoirse was bad. I passed out with exhaustion sitting up many a time. I also find my hair drops out when stress is worse. (eek!). What's your kitty's name?
Feeding little and often really helps. Based on great advice I got from members ShadowsMom and tiffmaxee, I initially fed Saoirse tiny, tiny meals on the hour since that can be much easier on the digestive system. Even if she was on her appy stimulant and looking for more, she only got the small amount and it worked very well. Our vet suggested plain chicken breast as an interim feed. For the first couple of weeks, I fed Saoirse finely minced home-poached chicken plus a 50-50 mix of water and the poaching broth. You could maybe try that, too. If you blitz it up in a blender to make it a soupy consistency, it could be syringe-fed. I gave her 8g minced chicken (about 1 tbsp) plus 1 tbsp broth and 1 tbsp water every hour. She got on well with it when her meds were on board and it helped to keep her hydrated (something you need to pay very close attention to with a pancreatitis flare-up). To help me get some sleep (and also to ensure Saoirse got fed in case I passed out again) I purchased some timed feeders so that her 'mini-mini-meals' would be dispensed hourly. They were a godsend then and they help keep her numbers good now. Petsafe 5 feeders seem to be the best on the market. Wish I had one! If you do go for a timed feeder, I woudn't recommend the PetPods I use for Saoirse. They're grand for her under normal circumstances (she's very quiet and gentle) but they absolutely will not offer any resistance to a cat on an appy stimulant intent on burgling their contents.
Over time I gradually increased Saoirse's meal sizes and increased the time between them. When I was trying to get Saoirse back onto a complete food, at first I couldn't find anything that wouldn't make her symptoms worse again. Eventually, on the recommendation of Eliz here, I fed her
Liquivite. It's a liquid recovery food - basically a chicken meat and chicken liver soup - and it really helped her. It's very low in carbohydrates and it has a very high moisture content (c. 90%) which helps with maintaining hydration. They sell 1- or 2-tin packs if you want to try it, and some vets carry it as well (good for post-operative recovery and treating diarrhoea). Word of warning - it does have quite a high fat content and might not agree with all cats with pancreatitis. Thankfully it suited Saoirse and supplied all of her nutritional needs through the crisis. (Did wonders for her coat, which was in tatters at the start of the flare).
Another thing to ask your vet about is a course of B12 injections. They're part of IDEXX's recommended suite of treatments for feline pancreatitis. They did WONDERS for Saoirse. Here's a link to the IDEXX publication:
Treatment Recommendations for Feline Pancreatitis
It includes all of the medications that have been mentioned here and would be a
very helpful document to use as a basis for discussion with your vet.
Re the appy stimulant, based on your post it sounds like mirtazapine - effects last several days and it can produce odd behaviour. Mirtazapine is a tetracyclic antidepressant and a very powerful serotonin agonist. It can induce
serotonin syndrome - a potentially life-threatening condition. Keep an eye on the odd behaviours or responses if your boy gets it again - things like dilation of the pupils, excessive purring, aggression/agitation, odd vocalization, personality changes, faster heart rate. The antidote for mirtazepine is, believe it or not, cyproheptadine. It's much gentler (and safer, IMO) than mirtazapine.
BTW other board members recommended the Bristol Labs generic ondansetron - apparently their formulation gets the best results in cats. DON'T let your vet prescribe Zofran (branded version of ondansetron) - it's insanely expensive. And don't let him/her use the cost of Zofran as the sole reason to put you off ondansetron as a possible anti-nausea treatment. Bristol Laboratories generic ondansetron is recommended as the best formulations for cats. It's a human drug and you can get 30 tablets for a tenner or so in the likes of Morrisson's Supermarkets pharmacies. If your vet agrees that it's a suitable med for your boy, ask him to write an Rx for it and get it from a local pharmacy if the vet can't supply the Bristol Labs generic version directly. If what I've read here is typical of cats with pancreatitis, you may need to keep the anti-nausea treatment going for quite a while. Saoirse got over the worst of her flare-up months ago, but it's only in the last couple of weeks that she has really got to the point where she needs only an occasional dose of ondansetron. Mind you, which brand of food she eats can lessen/exacerbate nausea symptoms.
Going forward, with pancreatitis kitties it's a very, very good plan to set up a little medicine chest of anti-nausea, appetite stimulant, stomach acid treatment and possibly something to treat diarrhoea (e.g. Pro-Kolin kaolin & probiotic paste) so that any recurring symptoms can be addressed without needing to wait for a veterinary appointment. It makes the world of difference to the management of the condition well when you can give the right treatment immediately. Also I recommend finding a few foods that agree with your boy and sticking to them. If you do need to change foods, transitioning extremely slowly can help to minimise any digestive system distress/diarrhoea/nausea symptoms.
You could try an omega supplement, but the response is very much down to your little one. From studying food ingredients and watching her clinical signs after eating, I've worked out that salmon oil is one of Saoirse's triggers, and the sunflower oil in Thrive Complete food upset her as well. Sarah's cat, Remi, is fine on the Thrive Complete despite probably being far more fat sensitive than Saoirse. With pancreatitis, I think the Every Cat Is Different rule may be even more applicable than for FD. If you're looking for healthy, FD-friendly treats Cosma Snackies chicken freeze-dried treat. They're just freeze-dried chicken. They are great for tempting reluctant kitties to eat. I blitz some up and keep the powdered treats in a little tub, ready to sprinkle on Saoirse's food if she's a bit hesitant to eat. Works like a charm. They're also a bit like kitty saltines for her - they never seem to upset her tummy. There were times when I just could not get her to eat. If she fasts too long, her BG spikes (liver dumps glucose into the bloodstream), so at those times I give her a small portion of the freeze-dried treats (about 2g) to help keep her pancreas ticking over and secreting basal insulin. The Cosma treats are available from Zooplus and Bitiba.
