Re: Taz has Pancreatitis

[Sharon and Taz]

Hi all. You were all correct in diagnosing Taz with pancreatitis. His fLP came back at 8.4 last friday. He continues to have little appetite and I feel like is I dont syringe feed him he cant possibly survive much longer. He does get up on my bed, urinate and God bless him, he still purrs for me and snuggles. I stopped forcing him to eat over the weekend and he ate maybe 1 3 oz can over the cours of a day with me putting it in front of him every 2 hrs. Unfortunately, I work and cant do that as much during the week. He hates anchovies even when well. I have gotten him to take some salmon and chicken. He also is a Fancy Feast kitty and has been less interested even before this event. I am still giving him nightly sq fluids but one vet told me to use NSS and another said Lactated Ringers. I was also tols to give him carbs aven though diabetics shouldnt have carbs. Taz is wasting before my eyes ans I need some input from you pancreatitis experts. What should I expect and what did you find most helpful in bringing your cat out of this? How long did it take? :sad:

 

[JJ & Gwyn [GA]]

We had acute pancreatitis twice. I got up every two hours, around the clock, and offered food and water so that Gwyn didn't need to make any effort. I also made sure the food was not anything Gwyn would have to "work" to eat -- ie, no thick pates that she'd have to break pieces off of, no lumpy something-in-gravy that she'd have to try to get on her tongue. I did use A/D, regardless of the carbs; it's nicely syringeable direct from the can. By the second attack (*years* later), I'd run a taste test and knew exactly what her favorite foods were, and she was only allowed those when she was ill, so we used a mixture of those and A/D.

Pancreatitis is extremely painful, so we re-arranged the area so that she didn't need to move more than necessary: the food and water were close by, and we moved the litterbox to several feet away. We tried to keep Gwyn on the floor, but she insisted that she preferred the couch, so we used the encyclopedias to build a very lowly sloping set of steps up to the couch so she could get up and down without jumping. Even so, I slept next to her and, at any indication that she wanted up or down, I lifted her up/down.

Sub-Q fluids were very necessary; my vet prefers Normosol-R, though other vets prefer LRS. I don't think it matters much which she gets, as long as she's kept hydrated. My vet also added extra vitamins to the fluids, to help.

The two things that we also did that I haven't seen mentioned in your post are appetite stimulants and painkillers, both of which I feel are very necessary.

The two main appetite stimulants are cyproheptadine and mirtazapine. Mirtazapine is longer lasting, but some cats can get really wired on it; for pancreatitis attacks, my vet prefers cyproheptadine. It needs to be given more frequently (every 12 hours), but caused less agitiation in the rest of Gwyn's system during a period where she needed to rest and preserve her strength. My vet also prefers transdermal appetite stimulants, which you gently rub on the inside of their ears, and I've found that I prefer that as well. If your vet can't supply exactly what you want, I'd ask if there was a local compounding pharmacy that could make some.

The other thing is painkillers; pancreatitis can be incredibly painful and it's easy to feel as if there's no relief in sight. Endless pain is *incredibly* draining. We went with buprenex. We started with .25mL every 12 hours, but it seemed to wear off toward the end of the dosing period. I asked my vet if it was okay to give half the dose twice as often (.125mL every 6 hours); she said it was, and that dosage seemed to work extremely well for us.

I have no idea how long flare-ups of chronic pancreatitis last; our two bouts of acute pancreatitits ran for about 6-10 days, from first symptoms to the point where the vet declared that Gwyn would recover.

(((Taz))) and (((you))) --

Jean and her Gwyn

 

[Vicky & Gandalf (GA) & Murrlin]

Here is an excellent pancreatitis primer from the old board:
http://www.felinediabetes.com/phorum5/r ... 722,876722

The post is from Jojo who's a vet tech if you aren't familiar and includes her best practices for treating p-titis.

The most important are the first 3 - subcutaneous fluids, pain meds such as Buprenex or buprenorphine and pepcid AC and, although it's controversial as some vets don't agree that the food matters, low fat foods.

In serious cases like I experienced with Gandalf, where they will not eat on their own for days, syringe feeding them or even having a feeding tube placed should be implemented to ward off fatty liver.

Take a look at our spreadsheet back in October, I have indicated beginning and end of his first major pancreatitis flare and it was about a month before all symptoms subsided. I considered a feeding tube, but after beginning him on a raw diet I did not have to go that route. There is also controversy about raw food, but I swear by it now. On ultrasound he had 2 pancreatic nodules and his ducts were inflamed, probably on his way to triaditis. 4 months later the nodules are gone. He receives 2 oz of raw mixed with can per day, as well as lower fat canned food such as some 9Lives varieties.

There has also been a post about low fat foods for pancreatitis kitties: http://www.felinediabetes.com/phorum5/r ... ?8,1259368

The Feline's Pride food listed is the raw I feed and although it's expensive, it may be worth a shot to get him over this hump. You can easily puree it in a blender to syringe. Get a large 60ml syringe from your vet.

Hope this helps. Hugs to you and Taz

 

[Cheryl and Winnie]

Hi Sharon,
how is Taz doing? better since this last post I hope.
-------------------------
He continues to have little appetite and I feel like is I dont syringe feed him he cant possibly survive much longer.

Have you tried assist feeding him? If syringing is difficult, you can make little meatballs out of a pate stype food and feed them to Taz. I do this w/ my kitty when necessary.
there is a yahoo support group for that which has many good tips :

http://pets.groups.yahoo.com/group/Feli ... d-Feeding/

also, as mentioned in other posts above. appetite stimulants are invaluable.
Please talk to your vet about these ASAP IF he is still not eating well.
cyproheptadine :
http://www.marvistavet.com/html/body_cy ... adine.html
mirtazapine:
http://www.veterinarypartner.com/Content.plx?P=A&A=2552

Other keys to treating cp that also may help with appetitie are nausea meds and pain meds.
1. nausea. even if Taz is not vomiting, it is likely that he is nauseous. since you are already giving him pepcid that is not enough. Please ask your vet about ondansetron. I have used it with both my CP kitties, as has many others on board. it is a very safe med.
Here are the dose ranges (dose is by wt) I gleened from papers by the top gastro/p-titis vets on the subject:

> Ogilvie: .22mg/kg 8-12
> Scherk: .1-.15 mg/kg 6-12 (slow push IV)
> Zoran : .5-1.0mg/kg 12-24
> Marks: .5-1.0 mg/kg 12-24
>
> My vet looked up in Plumbs to confirm dose ranges
It is usually given every 12 hrs.

also if there is vomiting, then cerenia is a good tool. It is given by injection and can only be used a limited number of days in a row. (usu 5)
http://www.drugs.com/vet/cerenia-injection-can.html

Pain can also cause inappetence buprenorphine is most commonly used for p-titis.
It is also very important to note that pancreatitis is a very painful illness and should be treated as thus.
Pain can prevent healing, and promote the cycle of inflammation.
here is an excerpt from a paper by marjorie scherk, dvm about pain treatment and p-titis:

Feline Pancreatitis: Underdiagnosed and Overlooked
Margie Scherk, DVM, DABVP (Feline)

Analgesia is of critical importance in the comfort of the patient, but also in the progression of the disease/inflammation through the negative physiological effects of pain. Pain causes disease and prevents healing. Even if obvious abdominal pain isn't present, use a "test dose" of 0.1-0.2-mg/kg oxymorphone IV to see if the patient improves over the approximately 6 hour effective period. If that is the case, then constant rate infusion of a narcotic may be considered or a transdermal fentanyl patch (DuragesicTM) for continuous relief. TorbugesicTM is not as effective for visceral pain as the opioid agonists are.

in other words, buprenex or fentanyl patches are best options for home care.




I am still giving him nightly sq fluids but one vet told me to use NSS and another said Lactated Ringers

Please ask your vets for their reasoning. on occasion, cats w/ cp are prone to lactic acidosis. in this case, or if calcium levels are high, then yes normasol tends to be the best.
otherwise ringers are fine. I use ringers w/ my civie. fluids are also an important part of treating CP

. I was also tols to give him carbs aven though diabetics shouldnt have carbs. Taz is wasting before my eyes ans I need some input .

in dogs, lowering fat and increasing carbs in diet has helped. In *most* cats, fat is not a factor in triggering p-titis. however ECID ( Every Cat is Different) some on the board have found it helpful to change up the diet and give moderate fat food. vicky and gandalf gave you the link to Cheri and Louis's list of mod fat /low carb foods for Cp kitties. If you want to try different foods to see if that helps, that is a great list to work from
Neither of my CP kitties were fat sensitive. However, I do like merrick's food as it is a better balance of fat to protein than most foods. It is on cheri's list.
THE IMPORTANT THING IS TO GET YOUR CAT TO EAT.
so offer him whatever it takes -- babyfood., a smorgasbord of different foods........ even dry kibble if that's what he will eat.
please try and get an appy stim from your vet. and/ or assist feed.

Another valuable tool in treating p-titis is prednisolone. As steroids raise BG levels, many with FD kitties try to avoid this. Pancreatitis is an inflammatory illness and it has become more standard treatment to treat p-titis w/ steroids, at least on a temporary basis. You can always increase your insulin and shoot around the steroid effect. It is always important for those with FD kitties to prioritize health issues. If treatment needs to be given that can increase BG numbers, not that big of a deal. you can adjust the insulin.

What should I expect and what did you find most helpful in bringing your cat out of this? How long did it take?


I hope you talk to your vet about these treatments and get more help for Taz.
From what you wrote, it sounds like something needs to change fast.
I have found that when my kitty is in a flare up I bring out all the tools in my treatment box and put them to work. It's best to nip it in the bud. Some cats have a flare up and that's it. others it's once a year. and others it is more frequent. It is manageable in most cases, with the right tools. --- nausea, pain, appy stim, fluids are key.

There are other supplements you can add as well if needed -- denasyl is a powerful antioxidant and excellent for liver support and w/ your cat's hx i would think that would be a good thing for him to be on.

If your cat is having any diarrhea-- probiotics can help. in fact forta flora also is an appy enticement ( very strong smell )
pre biotics -- such as prozyme that is plant based, can help your cat digest his food easier.

please also remember that if your cat is sick and not eating it is very important to remember to test for ketones.

I hope you post back soon w/ an up date on Taz.