Pancreatitis flareup, trace ketones

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Kara & Ember

Kara & Ember

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EDIT: New Thread: https://www.felinediabetes.com/FDMB/threads/pancreatitis-flareup-cont.292814/



So, I introduced her to the weruva this morning... and now she refuses to eat the m/d. It's time for her shot and Trilostane now, she's not eaten since the morning (and didn't eat all of her breakfast) because she's taking one look at the m/d and putting her nose up at it.

Do I try to wait her out for a bit? should I give her the weruva? I know we aren't supposed to transition too quickly to avoid GI issues and now she's doing this to me :(
 
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she is also sniffing water/food/treats and then licking her lips and swallowing a couple times? she seems to want food just not what I've offered so far.
 
annnd she just threw up foam (dunno if intentional, due to not having eaten, or nausea). The vet said to wait 30 minutes after she's done this before feeding her?
 
changing this to a 911 because she won't touch any of it. not the weruva on its own or on the same plate, or the m/d.

do I just bring her to the ER or do I call my primary vet to see if they can get me an anti-nausea?
 
Called both my vets; i’m thinking its possibly an unfortunately timed flareup because of all the stress from this month. Waiting to see if they will get me some anti-nausea or if theres another course they want to take.
 
Kara & Ember said:
changing this to a 911 because she won't touch any of it. not the weruva on its own or on the same plate, or the m/d.

do I just bring her to the ER or do I call my primary vet to see if they can get me an anti-nausea?
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Thos really does sound like symptoms of nausea. Do you have any Cerenia on hand. If not, I would ask the vet for an Rx for Ondansetron that you fill at a human pharmacy. It’s the best for nausea. Cerenia can also be used at the same time.
 
Does your kitty have a history of pancreatitis? Can you give sub-q fluids at home? If pancreatitis then Cerenia and fluids and a pain medication like Buprenorphine are needed.
 
Just picked up cerenia from the vet, and some big syringes in case i need to try to syringe feed. Vet also said to give her half a dose of insulin and her normal Trilostane.
So she’s getting those and also gabapentin for the pain. I’ve been able to manage these “flareups” with cerenia and gaba in the past. Vets think it was the food
 
I would ask them to give her some fluids too as long as she’s there. Stress is as likely as anything to cause a pancreatitis flare. But dietary changes always should be done slowly if at all possible and when moving from higher to lower carb in a diabetic cat.
 
normal vet is closed now. i did go very slow, only gave her a small scoop this morning and then she wouldnt eat the m/d anymore after that. heading to ER, hopefully just some fluids, cerenia injection and we'll see
 
Kara & Ember said:
normal vet is closed now. i did go very slow, only gave her a small scoop this morning and then she wouldnt eat the m/d anymore after that. heading to ER, hopefully just some fluids, cerenia injection and we'll see
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I hope so too. Good luck. Did you already shoot insulin?
 
Still waiting for a room, I’m 3rd in line.

The internist said it was “possibly because the weruva was higher in fat” but… its actually not? Idk, i feel like it would be more likely that the m/d is causing it 2 weeks after full transition. I’m not sure if anyone has any info about how long it might take for a food to cause a pancreatitis or IBD flareup? Both vets recommended I only feed the m/d for now.
Also the internist mentioned that her being a cushing’s kitty meant her chances at remission were basically none, which is… extremely disheartening if true :(
 
Kara & Ember said:
The internist said it was “possibly because the weruva was higher in fat” but… its actually not?
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GA Elmsley wasn't having the same issues your kitty is, however sharing that I tried to transition him from Fancy Feast to Weruva once his numbers calmed down and his kidney disease became evident. He wolfed the Weruva BFF down like it was going out of style, but vomited and had diarrhea regularly, and started losing weight we worked so hard to put back on him. We didn't put 2+2 together at first due to his other health issues, but it turns out he had a food sensitivity/allergy to (most likely) the thickening agent in the food. Once we took him off it the vomiting became more in line for his health issues and the weight came back on.
 
Drinking water, but still no interest in food :sob: tried freeze dried treats, dry and wet m/d, chicken and all get the same “eh” walk away treatment. Time to look up syringe feeding
 
Got a couple mls in with syringe feeding so far… guess i need to figure out how to give her an appy stim even with her two transdermals…
I need to get some gaba into her as well

edit: total mLs: between 5-6
 
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unfortunately, shes now laying in the tub and growling when i try to do more (to the point that if i dont stop, im def getting attacked).
So, i guess i go get a couple hours of sleep before i have to try and do her am insulin and possibly drive back to the ER. Going to leave food out for her just in case.
 
God i could cry (did cry) - was grabbing some dry food to put out for her and she came running. Broke my heart at first, thinking she was running out just to not eat, but then she started eating (with my help) - didnt eat much, but some. She also ate some of the wet i put down after. I wanna try to get some gaba into her via wet food, and then try to get a couple hours sleep
 
1u insulin, ondansetron and gaba given, trilo and methimazole given. Still wasnt interested in food besides a couple bites of wet, so put them down next to the bed and she came out and ate some more dry food. need to get some more sleep, and will see how shes doing in a few hours
 
She is definitely still not eating enough and no interest in wet foods; idk when I should be bringing her back in to be diagnosed. I probably need to bring her back to the big hospital (ER) as my primary vet has limited equipment. Im not really in the best mental state to be making decisions (I clearly should have just had them run diagnostics last night but it was so late and i was so sure she’d eat once she had the anti-nausea…)
Im trying to get some more sleep, but i dont want to wait too long, i just really dont know what i should be doing here.

libre from the last 24 hours since i cant update her spreadsheet right now. Both last night and this morning i only did 1u
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If she were my cat I would take her back to the big hospital to try and find some answers. She needs bloodwork and the spec fPL test for pancreatitis. If bloodwork isn’t giving answers, do they have the ability to do an ultrasound there and have someone who knows how to use it diagnostically (trained in interpreting ultrasounds- I don’t want you to waste money if not.) It doesn’t always follow that ER vets can do this, but if it’s a specialty hospital then it’s likely.
 
Brought her back for dx; they pulled her for vitals and then instead of bringing her back out (and then we get pulled into a room when ones available) they brought me into a room alone and just said “they’ll be in shortly with an update” wtf do you MEAN an update?? Update on WHAT?? Im trying not to panic but i have about zero emotional regulation right now :(

Edit: ok they came in and said shes doing great, going to start bloodwork and xrays
 
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Alright, bloodwork came back; def a pancreatitis flareup, and shes getting slightly dehydrated (higher protein in urine), and her potassium was low. Everything else was normal/as expected. Going to have them at minimum do some fluids while shes here, but the options are keep her hospitalized with a feeding tube or bring her home and try management with meds and syringe feeding/etc.

i hate hospitalizing her. I am thinking i can probably manage, but should i be trying different foods? Tuna juice? I have nothing with fish in my house right now but i can pick some up. Idk if feeding her a brand new food is a good idea or not, but i also dont know what caused the flareup (stress, m/d, weruva) so I dont want to accidentally feed her the thing that caused the issue to begin with.

any thoughts/advice would be greatly appreciated
 
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Can they place an esophageal feeding tube where you can feed her at home through the tube? It sounds much worse than it is and they’re not hard to manage at home and they require only a short time of perhaps 15 minutes under anesthesia. Otherwise, perhaps you should leave her there for a day or two. They must plan to put her on the nasogastric feeding tube which goes through the nose if they don’t plan to do an esophageal feeding tube.
 
Will she let you feed her at home with the syringes? She was growling before, right? Do you have anyone to help you? Is she going to her injections of Cerenia and fluids while there? What else is their treatment plan? Have they given you a detailed written estimate? Is she getting pain meds while there?
 
They did plan the nasogastric tube, and mentioned the esophageal as a possibility but would typically be a day 2-4 of hospitalization thing, not a day 1 thing.

the estimate mentions fluids, the tube, and estimates of injections/medications (he mentioned pain/nausea management)
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Suzanne & Darcy said:
You can always try it for 24 hours at home to see if you can manage. If not, take her back?
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Yeah; they did give her fluids, and sending me home with meds (mainly needed gaba restock and getting elura for appy stim)

i guess mainly my question is advice for feeding. Do i go pick up a bunch of things to try, do i give her stim and give her space to eat on her own? By the time we get home it will be dinner/pm shot time (and reup of ondansetron)
 
I’m glad you are using Ondansetron. But Cerenia is also valuable for Pancreatitis because of its anti-inflammatory properties. I know people with cats who have chronic pancreatitis and they give Cerenia daily. Hope Gabapentin will be enough.

Regarding food, she must eat so I would try anything. First try something she’s used to but move to other things if necessary. Maybe just a little tuna water on top of her regular food? Do you have Forti Flora to sprinkle on food? Parmesan cheese sprinkled on top? Pure Bites chicken treats ground up in a blender sprinkled on top of wet food?
 
Nope, none if it unfortunately lol but i can make a store run once i get her settled and meds done.

I do also have cerenia - forgot to add that. She got her shot last night around 10:30-11, (its 3pm now), im thinking i should just wait and do the cerenia with her breakfast tomorrow? Shes going to be getting the ondansetron with both meals, plus the gaba i think at 100mg should be once per day? I’ll ask them

she did eat a few bites of dry food in her crate while we wait for them to finish discharging us.
 
That’s pretty good that she ate in her carrier. Many cats won’t — due to being stressed.So she had no insulin yet today then. Well I hope she will eat for you. I am on Eastern time too. 3:09 here now. Waiting at an auto repair shop for a brake job. Cat is at vet (vomiting and not eating) and gotta pick him up before 6. It’s always something! What is your regular shot time?
 
She did get 1u this morning at 4 (4am/4pm are her feeding times). They are getting me some 50mg gaba so i can give that twice a day instead of the 100mg once per day.


Also got some fortiflora from them, and some churus - just got home and going to work through meds and see if she’ll eat dinner, then maybe head to the store to try to find some stinkier options that might entice her
 
So new med routine:

am:
Cerenia, ondansetron, gaba, trilo, methimazole, insulin

pm:
Ondansetron, gaba, trilo, methimazole, amlodipine, insuline, elura appy stim (I just read on the package it “may increase serum glucose for several hours after dosing. Use in cats with diabetes has not been evaluated and may not be appropriate”. They are aware of her diabetes - should i call back and confirm that this is ok for her?? Edit to add: i did call and they confirmed it was ok as it was temporary thing)
 
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So, she loves churus lol gave her 3 of those, and then she ate some dry md in between. She got all of her meds (went with 1.5u for her insulin because shes running high and she had eaten at least a bit, plus im sure the churus are high carb). I havent given the elura yet.
Also gave her a small helping of wet with the fortiflora, ate that up, plus i put 3mL of the blended wet (for syringe feeding) and she lapped that up too. Then gave her a couple spoonfuls of the blended with more fortiflora, and she ate most of that. Going to just leave dry out for her, and run to the store to pick up some more stinky food options to try and entice some more calories into her.
 
Ok so i got a few different options for fancy feast to try - is it recommended to try to offer it separately or mixed with her normal food?

she has eaten some more of her blended wet with parmesan cheese (but i was too optimistic and offered a bit too much lol).

i couldnt find a tuna that i trusted, but i got some temptations squeezables (walmart didnt have churus, i’ll have to look elsewhere tomorrow)

i also picked up some pure pumpkin to see if maybe adding that would be interesting for her (or just if she needs a bit of fiber help)
 
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