Questions about possible pancreatitis

[Voula]

Hi everyone. It has been a while since I posted an update. My Lucy has had some tests done in the past week as she has been having intermittent vomiting which has become more frequent. The other week it was four times in the week. So I made a vet appointment. All her blood test results were great except her glucose was high which we expected due to the diabetes and the stress of the vet visit, and the specific fpl which was high. The vet said it is likely that Lucy has pancreatitis but we should have an ultrasound done. Tomorrow we have an appointment at the university vet hospital to see the dental vet so we are going to have an ultrasound done too. Our vet thinks the dental can be done as Lucy is eating well and her only symptom is the occasional vomiting, sometimes during the night and sometimes after using the litter tray and sometimes after food. The vet also said we need to check for other conditions such as IBD so we will do the ultrasound and also to rule out other issues. I am praying it is something minor. I have noticed that just before Lucy was diagnosed with diabetes more than two years ago that she has had intermittent vomiting which she never had before. I have been giving Lucy cerenia which has stopped the vomiting, but with stopping the cerenia for a few days she had a vomit this morning again. I have started the cerenia again. Lucy's appetite is very good and so I am hoping it is nothing serious. If it is pancreatitis how long do episodes last or can it vary depending on the individual cat and is chronic pancreatitis always present? Thank you so much.

 

[tiffmaxee]

Hi. Long time no see. Sorry Lucy isn't feeling well. I'd definitely get that ultrasound. Pancreatitis has different symptoms with different cats. Max always became inappetent but rarely vomited and occasionally had diarrhea but never long enough to require medication for that. . The fpl is the correct test but other diseases can cause elevation such as CKD and diabetes. Max had it for 6-7 years and strangely less often appeared sick once he became diabetic. It's an ECID as well as each episode is different. Many say their cat just isn't acting right and can't put their finger on what's wrong. The one thing I learned over time was to make sure he got the cerenia/ondansetron until I was sure he was feeling really well and at the right dose for him. If you gave this already read the handbook on pancreatitis in the health section I believe. Here's my favorite article:

http://www.idexx.de/pdf/de_de/small...ine_pancreatitis_roundtable_discussion_us.pdf

Hugs and please let us know the ultrasound results.

 

[Voula]

Thank you so much. Yes the vet said that diabetes can cause an elevation of the specific fpl test. Lucy only has vomiting as a symptom. Her kidney test was great. I am very anxious about the dental and the ultrasound. Much love to you and thank you again for your support. It is interesting to read about your Max and his experience of pancreatitis. I hope all is well with you and yours and sending you hugs.

 

[Voula]

One more question. You mentioned diabetes can raise the specific fpl and the vet said that too. Does this mean that there is no pancreatic issue and that the diabetes just raises the specific fpl reading? Thank you again.

 

[tiffmaxee]

One more question. You mentioned diabetes can raise the specific fpl and the vet said that too. Does this mean that there is no pancreatic issue and that the diabetes just raises the specific fpl reading? Thank you again.

That's the problem. It's not easy to figure out which it is. When Max was first diagnosed with pancreatitis, his only other health issue was high blood pressure. He didn't even have CKD. what was the score on the SfPL ?

 

[Voula]

That's the problem. It's not easy to figure out which it is. When Max was first diagnosed with pancreatitis, his only other health issue was high blood pressure. He didn't even have CKD. what was the score on the SfPL ?

The reading was 23.5 on the specific fpl test.

 

[tiffmaxee]

So clearly a strong case for pancreatitis. Max read as high as 50! The ultrasound doesn't always show if it's pancreatitis but will show if there's any thickening of the intestines. How many hours will you need to fast her?.

 

[Voula]

Yes the report said it is likely pancreatitis. That is a much higher reading that Max had. You and Max did so well for him to live so long with pancreatitis. You are a great cat mum. The vet hospital said the anesthetist said to fast from midnight. Our appointment is this morning. Lucy's glucose was very high last night and I really wanted to give her a full dose of insulin. I had to delay yesterday morning's dose as her glucose was too low for me to give her the full dose as I was going to be out most of the day. So she has had two reduced doses. Last night's dose was given very late so I had to give the half dose then.

 

[tiffmaxee]

His was off the charts high at times and other times like yours or lower. We stopped testing and I just treated the symptoms the last year. When both cerenia and ondansetron didn't help I knew something else was wrong. If tge ultrasound is normal or shows pancreatitis ask for pain medication to see if that helps. It's good that Lucy is eating. Normal stool? Max only had loose a couple of episodes and they were likely acute. Vomiting a lot of the food? I hope you get good news.

 

[Sienne and Gabby (GA)]

Marje also put together information in a Primer on Pancreatitis that you may find helpful.

 

[Voula]

His was off the charts high at times and other times like yours or lower. We stopped testing and I just treated the symptoms the last year. When both cerenia and ondansetron didn't help I knew something else was wrong. If tge ultrasound is normal or shows pancreatitis ask for pain medication to see if that helps. It's good that Lucy is eating. Normal stool? Max only had loose a couple of episodes and they were likely acute. Vomiting a lot of the food? I hope you get good news.

Thank you so much. Stools are normal though possibly a little constipated at times. Often the vomit is small amounts of liquid during the night whether or not I leave food out. Sometimes the vomit is a lot of food but usually only when Lucy has eaten a lot of food if her glucose is high. I will let you know what the results are later on when we get them.

 

[Voula]

Marje also put together information in a Primer on Pancreatitis that you may find helpful.

Thank you so much Sienne.

 

[LizzieInTexas]

The Canna Companion works good for Gizmo's pancreatitis. I have been able to manage at home over the last year. Lots of added water to food. Just recently gave a couple doses of pepcid but have primarily used SEB for digestive issues. I started using Pancreas Booster and Glucos Ensure (you can see everything on the "meds" tab on Gizmo's SS)

 

[LizzieInTexas]

little constipated at times.

I just started Natural Moves but have been using Miralax. SEB will work too but can't give with meds or supplements (within 2 hours) so that is a challenge.

Often the vomit is small amounts of liquid during the night

SEB or Pepcid.

Sometimes the vomit is a lot of food

Smaller, more frequent snacks.



For me the hardest thing is trying to figure out if he is in pain or just tummy issues. I probably under medicate with pain RX and use supplements primarily.

 

[Voula]

The Canna Companion works good for Gizmo's pancreatitis. I have been able to manage at home over the last year. Lots of added water to food. Just recently gave a couple doses of pepcid but have primarily used SEB for digestive issues. I started using Pancreas Booster and Glucos Ensure (you can see everything on the "meds" tab on Gizmo's SS)

Thank you so much. It sounds like you and Gizmo are doing really well with everything.

 

[Voula]

Thank you for your replies. Lucy had a dental and just needed a clean this time with no teeth extracted. The ultrasound results have worried me and I am trying to process all the information. Firstly, Lucy has a peri-renal pseudocyst on one of her kidneys. We can apparently just monitor this for now. Lucy has IBD with areas of thickening in her small intestine. It is possible that it is small cell lymphoma but I hope it is not. No biopsies were done. Lucy's pancreas has nodules which apparently can be common in old cats and she also has cysts on her pancreas which are not that common but can be a result of acute and chronic pancreatitis. Both our general vet and the dental vet think the IBD has caused the pancreatitis. We can have another ultrasound done by an internal medicine vet in 2 to 4 weeks to assess for any changes in all of these issues. I think it is important that we treat the IBD and I understand the effects on glucose and diabetes of prednisolone. We can use budesonide instead of prednisolone but the vet said the level of thickening in the intestine is significant and she thinks the prednisolone might be more effective for the IBD. I would like to know if we are dealing with small cell lymphoma and I think we should see an internal medicine vet to get an opinion on treatment and considering whether we are dealing with only IBD. There is also a nodule on Lucy's liver but all blood tests except for glucose and pancreas are excellent. I need to try and sort all this out in my mind in the next few days.

 

[Bron and Sheba (GA)]

I am so sorry you are having to deal with IBD for Lucy. I know how worried you must be.
But I am glad you have had the ultrasound done and you know what you are dealing with and it sounds as if you have found it fairly early.
The psuedocyst on her kidney and the nodules and cysts on her pancreas sound as if they just need to be monitored...is that right.?
I think you are wise to see an internal medicine vet and get all the information you can to move forward with treatment.
I don't know a huge amount about IBD...although Maxie, Sheba's soulmate had IBD and I gave him prednisone for years. He did not have the complication of diabetes though and used to have 5 mgms daily with an increase to 10 mgms if it flared up. His appetite was always average at best and that was always my main struggle with him.

I'm sorry I can't give you any advice or help with this but I know there are many people here who have dealt with IBD and possible lymphoma so hopefully they will be able to advise you on the best way forward.
Please look after yourself as well .....I know that is easier said then done .......but you need to keep well to look after your precious Lucy.

 

[Voula]

Thank you so much Bron. The kidney cyst and pancreas nodules and cysts just need monitoring. The vet said they could not access the pancreas to do any testing of the cysts. It is likely that the nodules are benign and possibly age related and the cysts a result of pancreatitis. I thought I might contact the oncologists who treated my Rosie for some advice on the issues Lucy has and testing to differentiate between IBD and small cell lymphoma in the small intestine. I am very upset yes. Meanwhile we came home and Lucy was ravenous and has eaten two Whiskas pouches of low carb food and one of those soups for cats treats pouches. A good appetite is always good.

 

[Bron and Sheba (GA)]

I am so glad Lucy is eating...that is a big plus!
That's a good idea to contact the oncologist who treated Rosie.
An anxious wait for you I know.
Take care.

 

[LizzieInTexas]

You might want to post a new thread on the main Health forum (link back to this condo) and ask for IBD advise. I know there are others here that deal with it but can't think who they are. I know there is a website also for IBD - but can't find it either. Batting -0- this morning.

 

[tiffmaxee]

Fouls, I'm sorry the ultrasound report shows all these issues. I don't want to alarm you but in my opinion I think you need a biopsy immediately. I've been down this road before with my Tiffany with only severe thickening that turned out to be intermediate cell lymphoma. It is more aggressive than small cell. At the time I was told either IBD or lymphoma. Who did the ultrasound? You would want either a Board Certified Radiologist or a Internal Med Vet that does lots of them. If you start pred now without a diagnosis it will make a diagnosis difficult. The problem is that if it's not small cell and more aggressive you need treatment right away. Pred works and is part of all of these protocols but it's not enough if anything besides IBD.PM me if you want.

 

[Voula]

Fouls, I'm sorry the ultrasound report shows all these issues. I don't want to alarm you but in my opinion I think you need a biopsy immediately. I've been down this road before with my Tiffany with only severe thickening that turned out to be intermediate cell lymphoma. It is more aggressive than small cell. At the time I was told either IBD or lymphoma. Who did the ultrasound? You would want either a Board Certified Radiologist or a Internal Med Vet that does lots of them. If you start pred now without a diagnosis it will make a diagnosis difficult. The problem is that if it's not small cell and more aggressive you need treatment right away. Pred works and is part of all of these protocols but it's not enough if anything besides IBD.PM me if you want.

Thank you so much. I will make enquiries today. The vet seemed to say that even with biopsy the results might be inconclusive. It seems we would need a full thickness biopsy to have the best chance of an accurate diagnosis and that can only be obtained through surgery which is a frightening thought. I will make enquiries today with the university vet hospital and the oncologists who treated my Rosie as I know them well and ask them what I should do and who would they recommend for us to see. I want to do the best for my Lucy and I am not happy with a wait and see approach.

 

[Voula]

You might want to post a new thread on the main Health forum (link back to this condo) and ask for IBD advise. I know there are others here that deal with it but can't think who they are. I know there is a website also for IBD - but can't find it either. Batting -0- this morning.

Thank you. I will do that.

 

[tiffmaxee]

Tiffany was diagnosed by endoscopy which is second to the gold standard of exploratory. It depends on the location as to whether you get results which is why you want the opinion of someone very experienced. Needle aspirates are less prone to yeild results. Fingers and paws crossed.

 

[Voula]

Tiffany was diagnosed by endoscopy which is second to the gold standard of exploratory. It depends on the location as to whether you get results which is why you want the opinion of someone very experienced. Needle aspirates are less prone to yeild results. Fingers and paws crossed.

Thank you Elise. There is an internal medicine specialist at the vet hospital we went to who specialises in gastrointestinal issues, specifically IBD and pancreatitis and I have emailed our vet asking her for a referral to the specialist vet. My Rosie's large cell lymphoma was diagnosed by biopsies through endoscopy. I don't think you can get an endoscope through the small intestine so I don't know how the vet would do biopsies in Lucy's case. Meanwhile Lucy is recovering well from the anesthetic and the dental cleaning and she wanted to eat straight after we got home yesterday. I gave Lucy the full dose of her insulin tonight. I gave her a few reduced doses after the dental in case she didn't eat well enough. But she seems fine in her appetite now.

 

[tiffmaxee]

Eating well is really good so soon after the dental. You know Max had his first ultrasound done by a traveling vet. He found everything wrong with him and the general vet recommended exploratory. I went for a second opinion and it turned out to not be necessary and it was "only" pancreatitis. Max never had IBD or any type of cancer. My third opinion was Jory. If you have or can get a copy of the US report I'd post it and ask for his input. Don't be surprised if the specialist wants to do his own US. Max had a second one as my vet said the disc wasn't good enough. The best extra $550 I paid. I hope this turns out not to be serious.

 

[Voula]

Thank you Elise. That is good to know about Max's experience with the ultrasound and subsequent opinions. I hope to get an appointment with an internal medicine specialist next week. It will be at the same university teaching hospital that we had the ultrasound done. The ultrasound was done before the dental and as wonderful as the dental vet is, she did say she lacked experience in some of the things found. I know a lot about IBD as I have it myself and I also know that areas of scarring that might appear as thickening could be completely benign and not even signs of active IBD. So I think we need an internal medicine specialist given all the things that were reported in the ultrasound report.

 

[tiffmaxee]

Thank you Elise. That is good to know about Max's experience with the ultrasound and subsequent opinions. I hope to get an appointment with an internal medicine specialist next week. It will be at the same university teaching hospital that we had the ultrasound done. The ultrasound was done before the dental and as wonderful as the dental vet is, she did say she lacked experience in some of the things found. I know a lot about IBD as I have it myself and I also know that areas of scarring that might appear as thickening could be completely benign and not even signs of active IBD. So I think we need an internal medicine specialist given all the things that were reported in the ultrasound report.

Exactly. The traveling vet who did Max's first one was no good. Maureen had a similar experience with him. My IM who I went back to wouldn't even do it himself. He had a Radiologist he trusts do it. Keep me posted. I hope it's not a form of lymphoma.

 

[Voula]

Exactly. The traveling vet who did Max's first one was no good. Maureen had a similar experience with him. My IM who I went back to wouldn't even do it himself. He had a Radiologist he trusts do it. Keep me posted. I hope it's not a form of lymphoma.

I just had a look at the preliminary draft ultrasound report and it has the name of a veterinary radiologist on it. Hopefully it is just IBD. I will keep you posted for sure. I am waiting on the proper report as the draft report needs to be reviewed by other vets or radiologists at the hospital though the dental vet said the reviewed report would likely be the same as the draft report.

 

[tiffmaxee]

I just had a look at the preliminary draft ultrasound report and it has the name of a veterinary radiologist on it. Hopefully it is just IBD. I will keep you posted for sure. I am waiting on the proper report as the draft report needs to be reviewed by other vets or radiologists at the hospital though the dental vet said the reviewed report would likely be the same as the draft report.

Okay. One step at a time. Try not to let your mind wander. You also might want to list the report for Jory to read. Appetite still good?

 

[Voula]

Okay. One step at a time. Try not to let your mind wander. You also might want to list the report for Jory to read. Appetite still good?

Hi Elise. I just posted the report to both the feline lymphoma and feline small cell lymphoma groups so hopefully Dr Jory will reply. Yes my Lucy is eating very well so that is very good. She does seem a little tired but that is to be expected after the long trip and the general anaesthetic.

 

[LizzieInTexas]

Prayers for a positive (negative? ) report.

 

[Voula]

Prayers for a positive (negative? ) report.

Thank you so much. I understand what you mean.

 

[Voula]

We saw the internal medicine specialist and she recommends a full thickness biopsy of Lucy's small intestine where the thickening is as seen on the ultrasound. She would also like a biopsy of Lucy's liver and pancreas too to rule out any cancer in those organs. My Lucy has lost more weight this week and this is a concern as her appetite is quite voracious. We got home from the appointment and Lucy ate two cans of fancy feast over an hour or so and a tablespoon of dry food which was a treat for how brave she was today going with me on the long drive again after her dental last week and for co-operating with the vet. We are not doing the tight regulation protocol any more so Lucy does have the occasional treat of dry food now. The specialist is concerned that Lucy may have small cell lymphoma given her big appetite and weight loss and some of the things seen on the ultrasound. Lucy does have pancreatitis according to the local vet and the internal medicine specialist we saw today. The specialist said that Lucy is strong and her blood tests are excellent apart from glucose and the pancreas test and so now is a good time to do the surgical biopsy. She doesn't think we should treat with prednisolone and hope for the best though that is an option. I am very anxious about Lucy having an invasive procedure for the biopsy but if she keeps losing weight as she has then in a few months she might be debilitated and if we just use prednisolone it might interfere with the biopsies. The vet said a gastroscopy and biopsy that way are possible but the scope may not reach far enough into the small intestine and she also wants to get a full thickness biopsy to get the most accurate result and Lucy would need an anaesthetic for that too. She said they have veterinary surgeons at the hospital who will do the procedure and it is a routine procedure but there are always risks. It is a hard decision whether to just treat with prednisolone and hope for the best or get a proper diagnosis only because of the need for a surgical biopsy. In my heart I think it is the right thing to do to get a proper diagnosis and the vet said it is well worth treating small cell lymphoma as it has a long survival time with treatment. In regards to Lucy's diabetes I told her we are doing reasonably okay with that and when I told her about the bouncing glucose levels she said she could give Lucy a 24 hour glucose monitor for two weeks and get a good assessment for her levels throughout the day and night. She said she has found a lot of cats are getting too much insulin and instead of giving more insulin for high numbers they should be getting less due to bouncing. But we know all of that on this board. Thank you for your support.

 

[Bron and Sheba (GA)]

I'm glad you were able to see the vet specialist and get some answers.....but not the answers you wanted to hear I am sure. She sounds very good. I think you need to go with your gut instinct......think a few months down the track and where you want to be and what you want to have found out. Will you be happy with just having gone with the prednisolone or will you be more comfortable with knowing exactly what the problem is.
I think all vets have to say there are risks with any procedure......The same thing is said to humans when they have anything done. It sounds as if they are very good and caring there.
I am glad Lucy is eating well for you but sorry she has been losing some weight. I know you are worried.
You must be feeling exhausted after all that today and Lucy has had a lot done in the last couple of weeks.
It is a hard decision for you as I know you love Lucy so much and want what is best for her.
I know you will make the best decision for Lucy. You are a wonderful and caring mamabean.

 

[Voula]

I'm glad you were able to see the vet specialist and get some answers.....but not the answers you wanted to hear I am sure. She sounds very good. I think you need to go with your gut instinct......think a few months down the track and where you want to be and what you want to have found out. Will you be happy with just having gone with the prednisolone or will you be more comfortable with knowing exactly what the problem is.
I think all vets have to say there are risks with any procedure......The same thing is said to humans when they have anything done. It sounds as if they are very good and caring there.
I am glad Lucy is eating well for you but sorry she has been losing some weight. I know you are worried.
You must be feeling exhausted after all that today and Lucy has had a lot done in the last couple of weeks.
It is a hard decision for you as I know you love Lucy so much and want what is best for her.
I know you will make the best decision for Lucy. You are a wonderful and caring mamabean.

Thank you Bron for your wisdom and support. We are home now and Lucy is interested in eating and has eaten some food which is very good. She is a little unsettled but that is to be expected. The surgeon has prescribed some buprenorphine for today and we will get more from the local vet if needed. Lucy came through the surgical biopsies very well and she needs to take it easy for a few weeks and I have to be very observant for any possible complications for which the risk is higher in the first week. Hopefully there will be no issues. We will know the results of the biopsies in about one week. I am very relieved that the exploratory surgery and the biopsies went so well and now we can find out the cause of the vomiting and treat appropriately. Thank you again.

 

[Bron and Sheba (GA)]

I am so glad Lucy has had the biopsies done and is home again with you.
That is good she wants to eat.
Sending many vines for a speedy recovery and good results.

 

[Voula]

Thank you so much Bron. I am glad we did the biopsies so we can find out what is causing the vomiting and treat it. Lucy did well in the hospital and maintained her feistiness with the nurses. I am so glad and thankful she is home now. It has been a very stressful experience. I am so impressed with the specialist vets at the hospital we went to.

 

[suki & crystal (GA)]

Voula, just catching up with your news on Lucy, I am so sorry she is having problems at the moment. Sending many vines for a good biopsy report, and a full recovery. Keeping you in my thoughts and prayers while you wait for the results.

 

[Voula]

Voula, just catching up with your news on Lucy, I am so sorry she is having problems at the moment. Sending many vines for a good biopsy report, and a full recovery. Keeping you in my thoughts and prayers while you wait for the results.

Thank you so much Suki for your ongoing support. It means a lot and helps so much. Lucy is recovering well and is eating more each day so I am happy about that. Thank you again.