Pancreatitis and Fatty Liver Questions

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porchat

Member Since 2022
Hi all,
I made a post last week about my cat Freckles: https://www.felinediabetes.com/FDMB...is-and-hepatic-lipadosis.270099/#post-3012587

Unfortunately, it ended with me putting her to sleep. I have some questions about why it ended that way.
I know none of you will have any answers, I am just curious what you all think and if any of you had a situation similar to this. Her final week is at the bottom.

my questions are:
Have any of you dealt with refeeding syndrome and how was it managed?

Have any of you dealt with pancreatitis and Fatty liver and how was it treated?

Was this a “too many cooks in the kitchen” type of situation? She had a different vet every day/night shift and only saw the internist twice.

Basically, I feel extremely guilty and angry and so sad it turned out this way. She was my best friend. Did I put her in the wrong hands? Did I not ask enough questions ? She was my first pet and I feel like I failed her.
Whatever insight you have or anything is appreciated. I want to make the right choices the next time I have a pet in crisis.


Freckles final week:

Freckles went to the vet on Friday 10/21 for eating less than usual (but still eating). Blood work was fine, vet gave me Metronidazole and Mirataz.

That weekend- slightly eating but no improvements.
Monday(10/24) - she didn’t eat at all so I took her to the ER. They said it was Pancreatitis and “Probably” DKA. Did an ultrasound, confirmed Pancreatitis but everything else looked fine. The liver was a slight worry because she wasn’t eating.

Monday night to Wednesday (10/26)- was at that hospital treating her electrolytes, trying to get her bg at a normal level and trying to feed her. Ate slightly except on Wednesday at 1pm ate enthusiastically.

Wednesday 2:30pm- transferred to different hospital with internal medicine because they couldn’t get her electrolytes to stabilize and wanted a second opinion. Imo- she looked a little sick but had energy and didn’t look that skinny

Wednesday 9/10pm - Front desk lady brought her to me in about 2 min. She was either in a cage doing nothing or in her carrier still. She looked extremely skinny, much more sick than when I brought her in. I created a fuss and the front desk lady said the night vet was trying to avoid Refeeding syndrome which is why he didn’t feed her. Why she wasn’t getting fluids or electrolytes or anything is beyond me.

Thursday 9am- I get a call from the internal medicine vet. She asks me when the last time she was fed. I told her what I knew from the previous night. She tells me she’s not sure why he did that and she needs to fix her fatty liver and wants to put a feeding tube her in her but she never had dka. She says nothing about the pancreatitis. She says her electrolytes are off because of lack of food. I agree to the feeding tube.

Thursday 12pm - Operation. Woke up from anesthesia quickly.

Thursday 4:30pm- I pick her up. She has some energy to move around the room but looks out of it. Her eye is bleeding and they are unsure why and don’t see any cuts. They give me instructions of
Increase food intake 25% everyday. Feed 3 times a day of hills a/d slurry. 5ml of water before and after each feeding
-half a pill of cerenia before meal
-mirataz on ear before meal
-increase units of lantus each day until it’s at 3 units.
- scan freestyle libre and upload data.

Thursday(7pm) - at home. She eats one nugget of food and drinks water and pees immediately after. No poop this entire week. She sits in the loaf but perched on paws position. She is staring at nothing. Call vet - they say it’s probably the anesthesia.

Thursday(9/10pm) - back to the first ER(it’s closer to me. the internal medicine one is an hour away) she has low blood pressure and is cold (98 degrees). They give her a bolis(sp?), feed her +insulin and gabapentin. Her temp is still low (around 99) but blood pressure is back up to around 100 something. She looks miserable, skinny, and won’t close her eyes or change sitting positions.

Friday(9am)- she looks about the same as yesterday. Her Bg is around 350. Still won’t close her eyes. Can move but barely and is wheezing. Fed her +insulin

Friday(1pm)- call the internal medicine vet. Tell her about how she is and they schedule an 4pm appointment. She won’t move now.

Friday(3:00pm) - driving to the hospital. Her breathing/wheezing is increasingly more noticeable. Can barely lift her head. Laying in positions I’ve never seen before. And she is more yellow than before. But not a bright yellow.

Friday (4:30pm) - they say her liver is worse, her electrolytes dropped and they aren’t sure why. They suspect Refeeding syndrome but aren’t sure. They don’t know why her liver got worse even with food. They said her feeding tube was still in place and didn’t know what the wheezing was from. They don’t know why she won’t close her eyes. They say it’s okay to stop. that I’ve done more than most pet owners. They say with all the money in the world they aren’t sure if they can save her.

Friday (5:00pm) - They set her down on her favorite chair that I brought. She is breathing with her mouth wide open now. She extremely uncomfortable and moving in ways I haven’t seen before. I sing her the song I made up for her when I first got her. Her eyes finally close.
 
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First of all I want to say that I think none of this is your fault and that you did everything possible for Freckles. You took her back to the vets time and again tying to get her help.
In my opinion the level of vet care you got was questionable at times.


Have any of you dealt with refeeding syndrome and how was it managed?
I have never come across this in all the years I have been here. As far as I am aware it has not been an issue with any DKA kitties I have dealt with. With fatty liver, the treatment is for the cat to eat.


Have any of you dealt with pancreatitis and Fatty liver and how was it treated?
With pancreatitis the treatment is supportive……sub Q fluids if dehydrated, pain medications and antinausea medications and sometimes an appetite stimulant until the kitty has recovered enough to be able to eat again and have no pain.
I will tag @Sienne and Gabby (GA) and @Wendy&Neko as I know they had had a kitty with hepatic lipidosis and may be able to give you more details.


Was this a “too many cooks in the kitchen” type of situation? She had a different vet every day/night shift and only saw the internist twice.
Most cats have a different vet each shift, but they should do a handover to the next person, even if it is at a different facility and the treatment should flow on.
I don’t think Freckles was treated appropriately at times.

Basically, I feel extremely guilty and angry and so sad it turned out this way. She was my best friend. Did I put her in the wrong hands? Did I not ask enough questions ? She was my first pet and I feel like I failed her.
Please don’t feel guilty as you did everything you could. I would be angry too and of course you will feel very sad that it turned out like this:bighug:.
I don’t know how experienced the vets were but I don’t think they made the best choices at times. You did not fail her, you tried to do everything possible for her. And I’m sure she knew how much you loved her.
 
I am sorry for what you went through. :bighug::bighug: Losing your best friend is bad enough without being compounded by questionable care.

I retreated a foster with hepatic lipidosis with assist feeding. The other option used is a feeding tube. The amount I fed was under guidance of a vet. Smaller and more frequent meals were what was suggested. Refeeding syndrome was not something I heard discussed.
 
OMG, you did so much more than a lot of pet owners would do. I am so sorry and my heart broke for you while reading your post.
I am probably the least experienced of those that answer you regarding this but I do want you to know it is amazing how much you did.
Also, one thing I can share. The two times my guy got very ill with Pancreatitis he was at death's door and I was sure I was losing him.
Your kitty was sick and you did everything within your power, including ending her suffering. A true act of love.
 
Hmm.... I didn't get the tag.

When Gabby was diagnosed, she had DKA, pancreatitis, and hepatic lipidosis. They had her on antibiotics, were monitoring and adjusting her electrolytes, keeping her hydrated via an IV, and making sure she was eating. She was getting pain meds and an appetite stimulant. There was an internal medicine vet that oversaw her care. Obviously, that vet wasn't there 24/7 but there was coordination of care. Gabby was hospitalized for 3 days and there was no need for a feeding tube. Both my vet and the IM vet at the emergency hospital both warned me that many cats don't recover. Gabby and I were among the lucky ones.
 
I’m so very sorry and sad for what you and your best friend went through.

I think it will be really hard to know what happened, and that is a really tough part. But I do know that you did everything you could for your girl. I can tell from what you’ve said that you are a smart, kind, loving caregiver.

I consider myself pretty experienced with pet medical crises, but when I’ve taken some of my cats to the ER, I could feel control slipping away, despite however much I may have tried to check on everything and make sure they were doing everything I felt was needed. (ETA, there were also times when the stress and sleep deprivation of the crisis turned my brain to mush and I was at a loss for what to do or ask for). Sadly, the same thing happens with people and doctors. Sometimes it could have made a difference, and other times it wouldn’t have, but we all want to know that everyone is doing their best to help our loved ones.

I don’t understand it, but have experienced the same thing in my volunteer work with rescue cats where the vets didn’t prioritize nutrition for cats that hadn’t eaten in days and it can be really frustrating. They can put in a nasal feeding tube to provide nutrition for a few days. Even when we had asked for it, they didn’t always listen.

It is not possible to accurately diagnose pancreatitis just from the ultrasound. They can guess that it looked that way, but confirmatory testing would be needed. I don’t think having that confirmation would have changed treatment, though. You would still have wanted a feeding tube based on her symptoms, and once she stabilized you could focus more on treating her long-term health issues.

I hadn’t heard of refeeding syndrome, but I know we always were told to start very slowly with food intake to avoid problems in cats on feeding tubes. Based on a cursory web search, it does look like refeeding syndrome can be fatal but can usually (but not always) be avoided by gradually increasing food intake.

The high bilirubin in their blood that makes them turn yellow also makes them feel really crummy. That could be why she looked and acted they way she did. Although the wheezing makes me think of displaced feeding tube which they rechecked. But also wonder about pneumonia.

Freckles will always know how much you loved her. It’s hard not to think of their last days when they struggled, but remember the years of wonderful times you had and she will always be alive in your heart.
 
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So sorry to read this. I’ve lost a cat due to the vets not properly diagnosing and treating so know how tough it is. :bighug:
 
I'm sorry that I couldn't read your entire post as it hits way too close to home for me. I lost my Taz on the 21st from complications of chronic pancreatitis and I am still beyond emotional over it.

He fought with chronic pancreatitis and the only thing we could do was treat him with medications to try to lessen his pain. He had been obese his whole life and when he was diagnosed, we were told that his liver and heart were also slightly enlarged. In July, I requested ondansetron and began giving it to him along with Cerenia, and alternating between bupe and gabapentin. After a couple of weeks of this, his stool changed color and started stinking really bad, which I learned through research was most likely symptoms of liver problems. I cut way down on his prescription meds and tried more natural things but the damage was already done. I truly feel in my heart that giving too much of the medications were to blame in his case. Either way, I feel sooo much guilt that I couldn't help him and that I possibly made things worse by trying to do the right thing.

Anyway, again I'm sorry for your loss and my heart goes out to you.
 
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