Pancreatitis; non-diabetic cat

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toomanycats

toomanycats

Member Since 2020
~~~EDIT: Could folks possibly suggest decent wet food options for pancreatitis? She's currently eating Purina True Nature Chicken & Liver pate~~~

Hi all,

It's been a bit since I've been here -- you all were wonderful when I was navigating diabetes with my late kitty cat Buzzy. I know a lot of you have dealt with pancreatitis as well, which is why I'm back here -- now for Buzzy's "sister," Luna.

Luna has had at least 1 confirmed-by-ultrasound (I believe 1 other non-confirmed before that) bout of pancreatitis this past year, and we believe she's having another one now. We spent about 5 hours at the emergency vet yesterday, but they couldn't test (out of tests) or do an ultrasound (too busy) to confirm the pancreatitis -- we went with her history & symptoms (lethargy, nausea, anorexia, bloody diarrhea, elevated white blood cell count, mild dehydration -- I got her in fast) & began supportive treatment (anti-nausea, pain meds, appetite stimulant, and an antibiotic + fortiflora) as of last night. Oh, and she also got some fluids yesterday.

Anyways, so we're home & she is miserable. Yesterday, she would eat a little food; today, nothing. I've begun syringe feeding her. I have the prescription A/D (urgent care) food on hand from previous medical issues, so I am using that -- question 1 -- is that an OK food to use? I've gotten mixed advice on diet and pancreatitis. (Oh, edit: I've gotten food in her via the syringe feeding; I meant she'll eat nothing on her own)

And, really, question 2 is just...please share experiences?

She seems SO miserable & in pain even with the medications. I will, of course, be calling her regular vet first thing tomorrow morning when they open to, at a minimum, get her in for probably more injected Cerenia & fluids.

Have any of you been able to give injected Cerenia at home? She couldn't keep down the oral stuff yesterday; we're going to try again today and see if she can keep it down now.

And maybe see if I can give subq fluids at home if needed...I think that's something people can do at home, right?

They did mention that her spot glucose was high yesterday but seriously....of course it was....she's sick and was SO stressed (40 min drive, extreme drool from nausea, soiled herself in the crate)...of course her spot glucose was high poor baby.
 
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toomanycats said:
Have any of you been able to give injected Cerenia at home? She couldn't keep down the oral stuff yesterday; we're going to try again today and see if she can keep it down now.
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I have given many injections w/o problems. One thing is that Cerinia injections sting so just be prepared for the reaction of the cat during the injection, it is normal.
toomanycats said:
And maybe see if I can give subq fluids at home if needed...I think that's something people can do at home, right?
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I have given subQ fluids to many cats (and dogs). Key is to restain the cat so then doi not move during the puncture and when the fluid is going into the cat. Make sure you warm to fluids to body temp too to help avoid discomfort with the fluids going in.

What pain med?
 
Larry and Kitties said:
I have given many injections w/o problems. One thing is that Cerinia injections sting so just be prepared for the reaction of the cat during the injection, it is normal.

I have given subQ fluids to many cats (and dogs). Key is to restain the cat so then doi not move during the puncture and when the fluid is going into the cat. Make sure you warm to fluids to body temp too to help avoid discomfort with the fluids going in.

What pain med?
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Thanks. Luna is a VERY docile kitty, so I think she would tolerate it well, but we will see if she can even keep the oral Cerenia down today. I also hear there may be other, better ones for nausea?

Here are all the meds

Cerenia - 12mg
Mirataz - whatever 1 inch strip contains
Metronidazole - 50mg 2x daily (antibiotic)
and for pain it's Buprenorphine - 0.6mL 2-3x daily

oh and also fortiflora
 
Follow-up question that's TMI....

Has anyone seen diarrhea that literally didn't even look like stool anymore?
Her stool looks like normal diarrhea now, but last night, she had some diarrhea on the way home that looked more like just tan mucus & blood...I've never seen anything like it. It was gelatanous & looked almost more like snot than stool, but it came out that end... sorry, I know that's gross. I took a picture for the vet, but I won't post it here.
 
I'm sorry to hear Luna is having a pancreatitis flare. It's an awful affliction. :(

You could try ondansetron for the nausea as an alternative/adjunct to Cerenia (human drug, should be available from any pharmacy with a veterinary Rx).

Try finding something - anything - that Luna can eat with as little discomfort as possible. Tense meatloafing is a good sign to watch for with regard to determining what she finds more difficult to get down.

Raising food and water bowls up several inches so that Luna doesn't have to stoop to eat and drink might help.

I'd suggest trying food with and without Fortiflora. Sometimes it can make nausea worse.

Try feeding very small amounts of food frequently. It can be easier to get down. When Saoirse had her first (really bad) flare all I could get her to eat at the peak was finely minced home-poached chicken breast. I added a few teaspoons of the broth to each microfeed (about 1-2 tsps of minced chicken per feed) to help with hydration. Even at times when she only took the broth at least it kept something going into her tummy regularly and that can help reduce hyperacidity. Famotidine can help with that too (needs to be given with a 2 hour gap between it and other oral meds). Slippery elm can help to soothe the GI tract.

Some cats will take feline-friendly baby foods when they won't eat anything else (meat and broth only, no onions, chives, garlic or spices). There's a list of suitable products plus additional tips for helping a queasy cat to eat at the following link:

Persuading a cat to eat

toomanycats said:
for pain it's Buprenorphine - 0.6mL 2-3x daily
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She's certainly not being underdosed.

Another thing to watch for is frequency of bowel movements. Constipation can make things worse when a cat's having a pancreatitis flare.

In case you've not seen this before, here's a helpful resource (although it looks like you've got all bases covered):

IDEXX feline pancreatitis treatment guidelines

I hope your little one feels better very soon.

(((Luna)))


Mogs
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toomanycats said:
Follow-up question that's TMI....

Has anyone seen diarrhea that literally didn't even look like stool anymore?
Her stool looks like normal diarrhea now, but last night, she had some diarrhea on the way home that looked more like just tan mucus & blood...I've never seen anything like it. It was gelatanous & looked almost more like snot than stool, but it came out that end... sorry, I know that's gross. I took a picture for the vet, but I won't post it here.
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It's OK, we're cool with cat poop round these parts. :D

If it had a lot of mucus in it then that may be due to inflammation of the gut (many possible causes). If the blood is red then there is bleeding somewhere in the lower part of the digestive tract. (Blood from higher in the GI tract may be partially digested and can lead to black, tarry-looking stools.) Definitely something to tell your vet about ASAP, especially because of the bleeding. It might be an idea to gather a sample to bring with you tomorrow.

If the stools are tan and look a bit 'fluffy' like wet marshmallow that might be due to the pancreatitis (especially if they're really stinky).


Mogs
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Thanks @Critter Mom -- I currently cannot persuade her to eat anything on her own -- zero interest or movement or even sniffing at anything at all even when I try to feed it from my hand. The only way I can get food down her is through a syringe, so that's what I'm doing. She's not a fan, but she's a very docile girl, so it is possible to do.

Last time, I could coax her to eat some, but not this time. This is definitely a far worse episode.

Thank you for confirming she's not being underdosed on pain meds. It's very hard to tell how much pain she's in vs. being "drugged up." She's laying on her pillow bed in our basement right now and hasn't moved from there except to use the litter box or to walk away from me trying to syringe feed her.

No constipation; she's having diarrhea. I see some in the box right now & there was some there this morning as well + 2 rounds of it at the vet/on the way home last night. It's brown and looks like stool again now, but it looked....not like stool...last night. See my TMI description above.

Sigh... I hate my baby being in pain.

Thank you for the paper on pancreatitis treatment - reading through it
 
toomanycats said:
Thank you for confirming she's not being underdosed on pain meds. It's very hard to tell how much pain she's in vs. being "drugged up." She's laying on her pillow bed in our basement right now and hasn't moved from there except to use the litter box or to walk away from me trying to syringe feed her.
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Cats can become extremely lethargic at the height of a flare.

Buprenorhine can cause some level of sedation (though this side effect may lessen when the cat has been on it for a little while). Plumb's Veterinary Drug Handbook 2008 gives the buprenorphine dosage for cats as 0.01-0.03mg/kg q6-12h (also q8h). Assuming the formulation of Luna's bupe is the usual 0.3mg/ml formulation, 0.6ml bupe q8-12h is a really hefty dose. Is she a very big cat?


Mogs
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Is the vomiting projectile? Does the belly feel hard or bloated? Painful to the touch?

Did the vet at least do an x-ray to rule out an intestinal blockage/obstruction? It may be a bout of pancreatitis (especially given the “fluffy”stool), but they can sometimes have diarrhea “around” an obstruction, so I’m just throwing it out there as it’s always important to rule that out. Time is of the essence with obstructions.

Even if the vet didn’t have the snap test for pancreatitis, they can send out a blood sample to TAMU for an fPLI to get a specific numeric result (usually includes fTLI, folate, and cobalamin too). The snap test just gives a yes/no.
 
Critter Mom said:
Cats can become extremely lethargic at the height of a flare.

Buprenorhine can cause some level of sedation (though this side effect may lessen when the cat has been on it for a little while). Plumb's Veterinary Drug Handbook 2008 gives the buprenorphine dosage for cats as 0.01-0.03mg/kg q6-12h (also q8h). Assuming the formulation of Luna's bupe is the usual 0.3mg/ml formulation, 0.6ml bupe q8-12h is a really hefty dose. Is she a very big cat?


Mogs
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She is roughly 6 kilos
 
JL and Chip said:
Is the vomiting projectile? Does the belly feel hard or bloated? Painful to the touch?

Did the vet at least do an x-ray to rule out an intestinal blockage/obstruction? It may be a bout of pancreatitis (especially given the “fluffy”stool), but they can sometimes have diarrhea “around” an obstruction, so I’m just throwing it out there as it’s always important to rule that out. Time is of the essence with obstructions.

Even if the vet didn’t have the snap test for pancreatitis, they can send out a blood sample to TAMU for an fPLI to get a specific numeric result (usually includes fTLI, folate, and cobalamin too). The snap test just gives a yes/no.
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She actually only vomited once - 10 min after an attempt by me at oral Cerenia and it was just clear liquid - but a lot. Thats when I took her to the ER. We dont think blockage as she has not vomited at all except for that. I had asked for an US instead of xray but then they didnt have time, but by then she had had 5 hours observation and zero vomit.
 
Update - not even a sniff at lickable cat treat or even catmilk... a favorite.

more syringe feeding of a/d just another 5ml. She is not even wanting to move :( sigh.
 
toomanycats said:
for pain it's Buprenorphine - 0.6mL 2-3x daily
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toomanycats said:
She is roughly 6 kilos
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I wonder whether the bupe dose might be too high? My civvie, Lúnasa, is on bupe, she weighs 4.5kg and her dose is 0.1ml q6-12h (c. 0.02mg/kg - median dose). At that dosage rate (and per Plumb's), for her weight Luna should be on about 0.13ml (again assuming the strength of the buprenorphine you've been given is 0.3mg/ml). Your vet may have a reason for prescribing a higher dose but I think it would be a good plan to double-check it with them.


Mogs
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Note: Sometimes higher doses of bupe may be prescribed. For example, Saoirse was put on 0.33ml q8h for a few days when she was recovering from surgery (weight 4.5kg).


Mogs
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Critter Mom said:
I wonder whether the bupe dose might be too high? My civvie, Lúnasa, is on bupe, she weighs 4.5kg and her dose is 0.1ml q6-12h (c. 0.03mg/kg). At that dosage rate (and per Plumb's), for her weight Luna should be on about 0.13ml (again assuming the strength of the buprenorphine you've been given is 0.3mg/ml). Your vet may have a reason for prescribing a higher dose but I think it would be a good plan to double-check it with them.


Mogs
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So...I'm a dumb. I can't read. She's being given 0.2 mL ...I was reading the wrong part of the bottle (don't worry they are pre-measured syringes, so I haven't been overdosing). It's 0.6mg/mL and the syringes are preloaded with 0.2mL
 
Larry and Kitties said:
That seems a little high with a 0/6mg/ml concentration.
https://rawcvet.com/wp-content/uploads/2017/12/Oral-Bup-Info..pdf
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I think it's in range, albeit, yes, on the higher end.

Says above...
Plumb's Veterinary Drug Handbook 2008 gives the buprenorphine dosage for cats as 0.01-0.03mg/kg

She is 6kg, so her dose should be somewhere between 0.06mg and 0.18mg.

if 1 mL = 0.6mg, then 0.2mL = 0.12mg.
Every 12 hours, but every 8 hours was OKed if needed. I'm aiming for every 12, but she did get the first dose at 11pm last night and second at 7am...and now third at 6pm, but it should be every 12 hours from here on out. (I had to adjust it to make sure I'd be awake).
 
Question (posted in main post above as well)

Could folks possibly suggest decent wet food options for pancreatitis? She's currently eating Purina True Nature Chicken & Liver pate


--- we wound up back at the ER vet this morning since her regular vet couldn't get her in. More fluids & injected Cerenia perked her up a bit...but the vet wants me to stop the a/d and give her wet w/d food instead, but the ingredients are...awful... so I am instead giving her a mix of the a/d with a hydrolyzed protein one that I have on hand again from her last bout -- just to make it more easily digestible


But anyways it's being suggested maybe we change her food again off of the Purina True Nature. I am not sure what to look for. I had her on Natural Balance LID Duck & Green Pea pate at one point, but she really isn't a fan.

My other cat eats a mix of the Purina True Nature Chicken & Liver pate + rehydrated freeze-dried raw (stella & chewy chick chick chicken) ... should I do THAT for her? Do maybe just rehydrated raw for her? Or do I need to find a novel protein?... No idea

EDIT: and I like to keep her food diabetic-friendly even though she's not diabetic.
 
What helps will vary from cat to cat. I found with Saoirse that the stronger the smell of a food, the more it disagreed with her. It took a great deal of trial and error to find a food she could eat consistently (Sheba Fine Flakes in Jelly Poultry Selection, and only the chicken and turkey pouches).


Mogs
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Critter Mom said:
What helps will vary from cat to cat. I found with Saoirse that the stronger the smell of a food, the more it disagreed with her. It took a great deal of trial and error to find a food she could eat consistently (Sheba Fine Flakes in Jelly Poultry Selection, and only the chicken and turkey pouches).


Mogs
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Did you use any particular criteria when looking for one?

She doesn't vomit or anything on the food she was eating -- so I don't even know if her food is a problem or not -- the ER vet said we should go lower fat, but everything I've read has said you don't need to go low fat for cats.

I've seen "novel protein" and "moderate protein," but then of course I've had "NO CARBS" pounded into me from my diabetes experience.... so I'm feeling quite lost about what criteria to use
 
OK based on discussion elsewhere, it sounds like novel protein might be the best way to go. So, I've ordered some stella & chewy freeze-dried raw rabbit -- will rehydrate and feed that assuming she'll eat it (once over the flare)
 
Hi TMC,

toomanycats said:
Did you use any particular criteria when looking for one?
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Low carb, grain free, as few ingredients as possible (meat, broth, essential additives to make it a complete food).

toomanycats said:
the ER vet said we should go lower fat, but everything I've read has said you don't need to go low fat for cats.
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My vet advised that the latest research confirms that, in general, dietary fat levels aren't as big an issue for cats with pancreatitis as it is for dogs, but there can be exceptions to that. We had a cat here a few years ago, Remi, who had had chronic pancreatitis for years and he was extremely fat-sensitive. Sara, his mom, had a hard time finding a diabetic-friendly, lower fat food for him (might have been Thrive Complete wet food, but I couldn't swear to that in a court of law).

toomanycats said:
I've seen "novel protein" and "moderate protein," but then of course I've had "NO CARBS" pounded into me from my diabetes experience.... so I'm feeling quite lost about what criteria to use
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If I hadn't found a low carb option for Saoirse, I would have fed her *anything at all* that agreed with her and then managed her insulin treatment around the carbs. First and foremost, our little ones need to eat.


Mogs
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Thanks so much @Critter Mom for sharing your experience.
I believe the stella & chewy freeze dried raw rabbit (rehydrated) meets all of those criteria. Plus it's a novel protein she's never had, so if there is any sort of allergy going on (it's possible; she's had to be on Zyrtec bc she started losing hair on her ears/itching more) or any IBD, I think this would help.

Here's hoping she likes rabbit...
 
toomanycats said:
She doesn't vomit or anything on the food she was eating -- so I don't even know if her food is a problem or not
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I used to watch how Saoirse reacted to her foods:

* Did she show increased signs of nausea after eating (e.g. looking for the cat equivalent of the face a human pulls when they taste something disgusting).

* Did she experience discomfort after eating (hunching in a tense meatloaf posture, hiding behaviours after eating).

* Did it give her loose stool?


Mogs
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Ugh well....changed my mind...the rabbit stella & chewy food is wicked high in phosphorus, and I'm not comfortable with that.

Also, I just looked at the food chart and HOLY CARBS ...the hydrolized protein prescription food I've been mixing in today is 35!! % carbs! And the w/d they want me to put her on is 25% !!! NooOoOoOoo...

Um so....not sure if I should keep doing the mix of hydrolized protein with the a/d and just let her have all the carbs...or just go back to a/d for now since at least that is only 12% carbs. It IS higher fat, yes, but it's not off the charts on the fat...it's 55% & I've seen other foods be higher than that.

UGH so back to the drawing board.

Side note - the freeze-dried raw chicken stella and chewy I've been feeding my other cat (who, at least, is only 1 year old) is also wicked high. As is the wet food I've been mixing it with! ...AARGH
 
OK I wound up finding 2 potential foods:

Only Natural Pet Rabbit & Pork dinner, for which I can't find carb or phosphorus content for, but am feeding via syringe right now just to get her off of the poultry, onto rabbit & pork & ridiculously high carb prescription foods

And then Instinct Grain-Free Minced Recipe Rabbit Recipe, which is a little higher in carbs (I'm honestly seeing mixed numbers, but the highest I've seen is 13%), but she's not diabetic, so it's acceptable & it isn't too high in phosphorus 1.02% on a dry matter basis.

it's expensive though. The Only Natural Pet is a bit cheaper and is a pate, but I can't find carb content!
 
Hound & Gatos 98% Pork Formula is also an option if pork works out. 1.12% phosphorus dry matter basis and zero carb ingredients.
 
If I can get over the phosphorus, regular Instinct rabbit is likely an option. It's just...nearly 2% phosphorus...it's a lot. Her kidney numbers are reading fine, but she's older & I don't want to destroy them! Why is food so hard...
 
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