Pancreatitis diagnosis - need advice

[Kelly & Oscar]

So I have finally received Oscar's fPLI test back. He was a 7.5 with the reference ranges of 0.1-3.5, so definitely up there. (test done through antech) He has been on amoxicillin tablets for a week now since his WBC is elevated. (his blood work is in a tab on his spreadsheet) Oscar's temperature has been running low for the past 3 weeks (in the 98's), but last night came up to 99.4 - so getting better. I was able to get another round of antibiotics today (amoxi) since that seems to help his temp a bit. Vet is referring us to a specialist for a possible ultrasound. Mentioned putting him on I/D by Hills, which is 24% carbs and way too high for a diabetic. It is supposed to have pancreatic enzymes in it too, and I asked about supplementing with that, but she wants us to see the specialist. He hasn't been gaining weight since December when we noticed that he had lost almost 2 pounds. His poo is a light color - kinda tan/gray-ish, but solid.

She didn't think he was in pain, so wouldn't give pain meds. But I think he is in discomfort due to the way he acts, which is also why he has been to the vet so much in the past year. I can tell something is off. He pukes on rare occasion, but he really isn't a puker at all, so when he does, I know something is off. Last time he puked was maybe 4 weeks ago. He has been very hard to regulate (on insulin for 2 years now). He is very frequently in the meatloaf position, but will snap right out of it if you stoop down to pet him. He has been licking his right side more, and has a shorter section of hair there because of this. I am unsure of having an ultrasound done. I don't know how much it is needed. Plus if his belly has to be shaved, he probably won't grow the hair back. (his neck still has short hair where they shaved him 2 years ago for a blood draw)

He currently eats Dr. Lisa's raw diet. There have been a few bouts where he was on FF classic chicken when I couldn't get around to making a batch of food. Is there a better diet out there for pancreatitis? I know there is debate over the lower fat content for cats since they process their food differently than dogs and humans.

So it is back to the waiting game. She will send in the referral this afternoon hopefully. I will call the specialist practice up in Indianapolis tomorrow morning before work. Hopefully I can get an appointment on Monday.

 

[Ann & Scatcats]

Do the ultrasound scan. Then you will get it visually right there and then, whether the pancrea is swollen or not yet. Here we are in the room while the u-sound is being done, helping out by holding the cat or the nurses holding the cat and I cheer on and tell him what a good boy he is. IMHO I think it is better to have a shaved belly with hairs that won't grow out, than a pancrea swollen and full of scar tissue as can happen. Also the things in the area around gets inflammated, which they also can see on the u-sound.


Foodwise, I have given Simba m/d, but if Oscar is on raw why not keep feeding him that? That's low fat.

 

[Kelly & Oscar]

What do they do for him if the pancreas is swollen?

 

[Ann & Scatcats]

There is anti-inflammatory they can use - various kinds that cats can tolerate. We had good success first time with Tolfedine, it's tolfedam acid the substance. With cautions though since it also gives stomach ulcers if used too long or in wrong dosage.

Also then most likely in pain - so Simba has been given pain relief stuff, some bad as Tradolan, and some in house only as Temgesic (buprenorfin substance) which I however could buy from the hospital. As well with Tradolan, I don't like Metacam either. I prefer the Temgesic.

 

[BJM]

" kinda tan/gray-ish, but solid"

Sometimes, the pancreas can reduce production of digestive enzymes. This can cause the light gray stool ("putty" colored) that you are observing. If this goes on and doesn't resolve, it may be a condition called Exocrine Pancreatic Insufficiency (EPI). A TLI test is one way to test for this and powdered enzymes (OTC) may be needed to enable the cat to digest food.

ETA: Also, if he isn't able to digest fats (is he losing weight? scruffy coat? oily?), an increased carb level will provide him with much needed calories. The insulin level may need to go up, but we say to treat the more complex disease and adjust the insulin as needed around that.

 

[Charlies_Mom]

Kelly & Oscar, so sorry you're having to deal with this too. I also have a cat (Molly) with SEVERE pancreatitis. She is 16 years old and her fPLI score was 13.8...yes, you read that correctly, 13.8!! I don't know how she's still alive. When she was diagnosed, I learned a lot about this disease. I had to keep her on amoxicillin & metronidazole (together) for a total of FIVE weeks to clear up the infection in her gut. You may want to ask the vet about adding Metronidazole with the amoxicillin, as this combo is frequently given to pancreatic cats. It worked wonders for Molly and totally cleared up her rampant vomiting and diarrhea!

I also had to switch to a totally liquid diet because cats with pancreatitis have intestines that are swollen, damaged, and scarred, and dry food only further damages the intestinal wall as the hard pieces try to make their way through. I had to feed Molly liquid food by syringe for the entire 5 weeks (I/D food blended with water, plus some wet A/D food blended in there because Molly had lost half her body weight within the past year); I added 1/2 capsule of pancreatin enzymes (purchsed from Vitamin Shoppe) to the food to help aid digestion because pancreatic cats can no longer make these digestive enzymes themselves, hence the gray stool/diarrhea/vomiting/inability to properly digest food. I must say, however, that I have been told by vets that pancreatic cats should NEVER be on a raw diet. I was told that a raw diet makes the pancreas have to work even harder to try and digest and can end up killing the cat in the process. Plus, the influx of bacteria and possible parasites from raw food is not something a pancreatic cat's body can handle.

In addition, I started Molly on Carafate/Sucralfate every day, which is a medicine to help heal her intestinal wall and intestinal lesions. I gave her an appetite-stimulant (Periactin) as well because she wasn't eating. Molly, too, frequently lied in the meatloaf position and simply looked miserable, so I asked for pain meds. I started her on Buprenorphine given as a gel that you smear on the gums (completely safe for cats) and she no longer lied in the meatloaf position. Buprenorphine ("Buprenex") is somewhat expensive, so I switched to 1/8 of a tablet of tramadol after that. If Oscar's in the meatloaf position, he IS in pain.

I know this a lot of info and I probably sound nuts, but Molly was on death's door with her pancreatitis until I began the regimen described above. She still has flare-ups from time to time, but her stool has hardened (and is normal-colored), she isn't in chronic pain any longer, and her appetite has increased and she's gaining some weight back. I think the liquid diet and antibiotic combo were what saved her. Grinding Oscar's I/D food down with water into oatmeal-consistency will give his intestines and pancreas a much-needed break. If he won't eat it straight from the bowl this way, syringe-feeding is needed but I understand it takes a lot of time and hassle.

I'm attaching a PDF file about treatment recommendation for pancreatic cats. I've already discussed some of the treatments here, but thought you might want to read it. Good luck with Oscar!!