So Now That We Know It Was Pancreatitis.. What is Next?

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ToddyTiger

ToddyTiger

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So, after all the blood work, Xrays and ultrasound, we know that Todd had Pancreatitis (I say had, because the ultrasound told them it looked like it was healing)

The problem is, he still isn't at 100% yet. Monday to Wed. last week, they had him on IV fluids during the day and home at night. He perked up SO much. He was eating like crazy. One day he had close to four 5.5oz cans of food! They took the IV out on Thursday and that was that. He did fine over the weekend and even on Monday he was good. But yesterday and today, Todd is back to looking really bad and not wanting to eat. I am baffled and so was the vet yesterday. I took him in for Sub-Q fluids yesterday, because he looked like he needed it. The vet was surprised and thought he should look a lot better at this point. But he doesn't. I mean, like I said, he was great all last week and over the weekend, it's just been yesterday and today he is looking bad and refusing food again. I am not sure what to do.

I gave him some sub-q fluids about 20 minutes ago. He perked up for a sec, then went back to looking yucky. He doesn't seem horribly dehydrated, to be honest. He is drinking water and has been eating only canned food.


*EDIT I do want to point out, our vet thinks he may have IBD a bit, so if his weight doesn't pick up within the next day or so, she wants to start him on a steroid. Not Pred though, it was something else that she said targets the GI more. I do not recall what it was called though.


Is this how Pancreatitis works?.. ups and downs like this over long periods of time?.. will it ever get better? I mean, honest to God, last week you would have thought he was totally fine and now he looks bad again.

I am leaving to go out of town tomorrow until Monday morning. Our vet is going to board him for me, so he will get care during the day and all weekend, but he will be alone at night. I am wondering if I should request that they give him IV fluids during the day while I am gone? That would give him 4 days of being on fluids. I really don't think the Sub-Q fluids are cutting it for him. They don't seem to be doing a dang thing for him.

He has been on a TON of medication since this all started in early July. Three antibiotics, pain meds, antacids, anti-nausea meds, B12 injections, B complex, Sub-Q fluids, Potassium.. just tons and tons of medication. We are down to just a few now.. his CURRENT list of meds are as follows:


Lantus 1 unit twice a day
Metoclopramide 1/4 tablet every 8 hours
Mirtazapine 1/4 tablet every 72 hours (got it on Monday, due again Thursday)
Pepcid AC 1/4 Tablet twice a day
Buprenorphine 0.25 twice a day (Took the last of it last night)
Tumil-K Potassium tablets 1/2 twice a day

I just don't know what else to do for him.
 
Hi,

My guy has been dealing with this off and on for a while including the vet stays. From what I have learned with my guy (ECID) and from my regular vet, it can take a long time for the pancreas to heal and some cats are just very sensitive. (I just posted a Pancreatitis and food question here this AM) Ditto for my guy, the long list of meds but we also have pred in the mix. My vet ended up adding the pred because he just wasn't coming around. He did say that you have to gradually back off meds (always w/pred) as it does take time to heal. Back off too soon and they may just flair up. He also noted that bup is a narcotic and if they have been on it for a while (don't know how long that is) they need to be backed of gradually. I think for some cats ptitis may be a one time event and others it is chronic and one just tries to "manage" it.

An interesting vet roundtable discussion on Pancreatitis: http://www.idexx.com/pubwebresources/pd ... rticle.pdf
 
Hi Amy,

He has been on the Bup off and on since late July. I kinda don't notice a change in him when he is on it anymore, so I have to wonder if it is even doing anything for him.

I am starting to think a steroid wouldn't be a bad choice for him. Our older kitty, Sly, who passed away last year, was on Pred for the last 4 years of his life. Every day, twice a day. It made him feel a lot better and kept his appetite up. This is what Todd needs badly. I don't think his current appetite stimulant is working anymore, or if it ever was. But I do know that the IV fluids made him loads better. he felt plump, rather than thin and boney, and he looked and acted better overall.

Has your guy needed aggressive IV fluids? I am wondering if a weeks worth of IV fluids (rather than Sub-Q) would be better for Todd?..

Thank you for the link. I'm gonna check it out right now!
 
His two vet stays included IV fluids but I have not done them at home as he just wouldn't tolerate it. I did SubQ with one of my old kitties for a long time but Pedro is a whole different kinda guy.

As much as I hated to see him go on to pred - it has helped him in terms of feeling better. But your vet may have something else in mind. And if he has IBD that just adds to the issues of eating.
Pedro did the same thing twice after the vet visits- perked up brifly and then pooped out. My regular vet thinks he may have come off meds a bit too early in his last go round and so saw a quick slide back into Ptitis. Have to say that after learning to deal with diabetes I've actually found this to be more challenging as it is more "invisable" - you and I can't test - we just have to go by what we observe.
Pedro has been on a very low level of cyproheptadine as an appetite stim and he gets hungry usually within 1/2 hr of taking 1/4 pill. This is a really low dose but for him it works. I occasionally have upped him if he isn't eating well.

It's good that he will be staying with your vet while you are away if he isn't his usual self.
Hang in there.
 
Is Pedro having weight loss issues as well? Todd seems to be dropping weight.. though with IV fluids, he went up a few ounces, but is now back down again. The weight loss scares me. I can feel his boney hips and spine (near the tail) though I cannot feel his ribs.

Is cyproheptadine a every day med, or is it every 72 hours?.. I might have to ask my vet about this.

I am finding this to be the hardest thing I have ever had to deal with. I am thankful though that it isn't cancer, as they were thinking it might be. But this is still very, very hard and there is no clear answer on what to do, or how long until he gets better.

Thank you!
 
So I talked to the vet and he said I should bring him over as soon as I can and they are gonna get him hooked up to IV fluids. I think it's a good idea, he is just not feeling well.

I'll update tonight when I have more info. :)
 
Glad he is going to see the vet. They will hopefully get him feeling better soon.
Yes, Pedro lost weight - due to no appetite. He also had loose stools and some vomiting - not at all uncommon with ptitis.
(AND he does have Cushing's disease which he is now on meds for too)
He was on cypro 2 times a day but as his eating has been improving he is currently only one time a day. His weight is at a good level now even though he is still dealing with ptitis.
Fingers and all paws crossed.
 
Your kitty could also be losing weight if there's low potassium.

Tucker has chronic pancreatitis, IBD and low potassium. I see that your little man is on Tumil-K Potassium tablets, so I have to assume you have low potassium also.

Pancreatitis flares come and go. Stress can cause it, a belly ache from the IBD can cause it, sometimes Tucker's allergies will cause a flare. We keep subqs, pain meds and injectible pepcid on hand. To help prevent cp flares he gets a bi-weekly B12 injection.

Have you seen the post written by Jojo? I've copied and pasted it below, just in case you haven't seen it.

chronic pancreatitis (or does my cat have a pepcid deficiency?)
Posted by: jojo and bunny(GA) and Y (IP Logged)
Date: December 13, 2007 10:26PM

things are going great. diabetic fluffy is nicely regulated. and then one day...just seems "off". BG numbers are higher. not eating much. maybe vomits later that night. hunched up in the 'meatloaf' position. lethargic. what is going on? you listen to the freely dispensed pepcid advice off board and after a couple of days fluffy seems to snap out of it. pepcid rocks! and recommend it to the next person on board that posts about their diabetic cat being "off".
however a few weeks/months later fluffy goes through the same episode. and again. and again. some of the episodes are worse than others. that last attack was bad and you got scared and fluffy was hauled off to vet for some basic blood work. yet nothing really abnormal on the results. is this just a normal part of being a diabetic cat? does your cat have a basic pepcid deficiency??? no.

it is estimated that AT LEAST 30% of all diabetic cats have what is known as Chronic Pancreatitis (CP). makes sense, the pancreas is the weak link with diabetics, in fact CP could be the causative factor on why fluffy became diabetic in the first place. simply put the pancreas has 2 types of basic functions the production of metabolic hormones (like the one everyone knows about, insulin) and the production of digestive enzymes. with pancreatitis it is the production of those digestive enzymes that is out of whack. when the pancreas 'misfires' and activates those digestive enzymes too early, the pancreas actually starts to digest itself and then the surrounding tissue and nearby organs, and systemic inflammation and toxin production ensues. there is a close link between CP with IBD and Cholangiohepatitis, (all three together collectively known as Triaditis).
so what now?

the best diagnostic test available is the fPLI (feline pancreatic lipase immunoreactivity ) [www.vetmed.wsu.edu] not perfect but far better than the options we had in the recent past.
it is far better to have a diagnosis (always) because then you and your vet can form a plan better than just pepcid. SQ fluids and pain management top the list. CP flare ups ARE painful...look carefully at how your cat is acting, it is not easy to tell when a cat is in pain, they hide it well. it is not just nausea that is keeping fluffy hunkered down under the chair, it is pain.
possible tools your vet might have you use:
~SQ fluids
~ pain meds
~ anti-nausea meds (hey look pepcid falls in this category)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed
~ +/- appetite stimulants if needed (and if liver not involved, some of these are contraindicated with liver issues)
can all be used to help the cat through the flare up. your vet can work up a treatment plan for managing your cat's CP flare up attacks.

the veterinary community is still undecided on the issue of fat content of food and whether or not it is something to be considered in feline CP. it is very much an issue in human or canine CP, however felines are very unique in how they utilize the fats (and protein) in their diets. anecdotally, some owners find that lowering the fat content (to about 35% or less) of their CP diabetic cat's diet even though it means they have to raise the carbs helps. ECID, you would have to experiment on that yourself. just a reminder on the topic of food..as a CP flare up begins cats will eat less in the days leading up to it and often not eat at all when the attack is in full force, know that it does not take many days of reduced calorie intake to make hepatic lipadosis possibly rear its ugly head, especially in a liver already compromised.

cats that are simply diabetic with no other condition going on should not need pepcid ever...if you are reaching for the pepcid again, maybe reach for the phone and call your vet instead and discuss the possibility that your diabetic cat might be one in that 30%.
 
Amy,

Poor Pedro! :( I am glad he is doing a bit better though. I just read a bit about Cushing's and that sounds awful. Poor guy.

Todd is still at the vet. I'll go get him in about 30 minutes. I guess they will have him come home tonight and tomorrow morning I will take him back. He will stay there until I get home on Monday. I wish I had someone that could bring him home at night and be with him. I am sure he won't like being alone at the vet office all night, and I am sure I will sleep poorly thinking about him being alone. :(

I just hope he is doing better with the fluids. I told the vet I really felt he would benefit from being on IV fluids while I am gone. I hope they do this and it helps make him feel better.


Tuckers Mom-

He did have low potassium. When they did another blood panel last week, it was back within the normal range (also his kidney values were back to normal, they were all going up a week before), so they had me bring him down to half a Tumil-K tablet twice a day, rather than a whole one twice a day. That could be why he feels bad, maybe he needs a whole tablet twice a day to stay normal.

I know Pancreatitis can be triggered by stress, and I have to wonder if he is upset at our foster kittens? We have two of them right now, and normally they would stay in the guest room, away from everyone, but on Sunday night, my husband decided they should come out and be with everyone, so they have been out ever since. Perhaps Todd is getting worse now due to the stress of the kittens? They seem to be leaving him alone and he doesn't seem to be bothered by them.. but maybe he is and he just isn't showing it? I just don't know. I feel awful about that and I hope I can find them a home right away so Todd won't be upset by them.

I have seen the post by Jojo! Thank you for sharing it though, I read through it again incase I missed something.

If the IV fluids are the only thing making him feel better, and the sub-q fluids are not helping, I have to wonder how I will maintain his health? I can't do IV's at home This is so very stressful.

Oh, and since you brought it up, I totally forgot about this. He got a B12 shot yesterday and he also got one last week. So he is getting B12 injections.
 
Ok, he is home now..

They gave him 75ml of IV fluids, because I had given him 100ml via Sub-Q around 11am. They said he ate about 1/4 of a can of i/d, which is better than nothing. he ate a tiny bit more when we got home and he had three of his Hypoallergenic treats. He does look a bit better, but not great, but better. Though I wish he could be with me until we leave tomorrow night, I will be dropping him off at the vet early in the morning so they can get him hooked back up, so he can get a good amount of IV fluids tomorrow. I'm gonna try to stop by and see him before we head for the airport. I asked my mom if she would come visit him while we are gone. I think that would make him feel better. I hope she does.

I hope so very much he starts feeling better soon. I just want him to be well again. My poor baby.

Send lots of good, healing thoughts Todd's way, please!!

Thank you all! I'll try to update again tomorrow afternoon before we leave.
 
Sounds like you and your vet are staying right on top of this and I think that is really key with pancreatitis.
At the least you know he is in good hands for the weekend. Hope your weekend is a good one.

Pedro's blood work is due back today or tomorrow and I will be very intersted in seeing what his potassium levels are like. His were "boarderline" last time but the vet didn't want to add to his already loaded plate. He has been more subdued of late so good to read the response and info here about it.
 
When you're in the middle of CP flare pain meds can be given every 8 hours. Ask your vet about that. It seems that sometimes pain meds are under prescribed.

Your home sounds so similar to mine with Tucker having many of the same ailments and my own husband always letting foster kittens out to run around.

Did the vet mention retesting the potassium next month? We check Tucker's monthly and even doing that I found just last week he was lethargic again and his potassium went to low again. ECID (every cat is different) so your kitty may never go low again, but just in case watch for lethargy and unexplained weight loss.

Injectible pepcid really helps Tucker when his CP is flaring. Tucker also did better on lower fat foods. He eats only grain free canned food, usually the Fancy Feast.

He recently had to start steroids for something else so we've been able to gradually add in some higher fat foods, trying to put some weight back on him since losing too much from the potassium loss.
 
Tuckers Mom-

They are going to retest the potassium. Possibly while he is staying at the vet, I am not sure. But they do plan on testing it again, along with the kidney values, since they were all off a few weeks ago.


I dropped him off at the vet around 8:30am today. He ate a little of the i/d wet this morning and had a couple of treats. But he didn't seem super great. Last night he was better though. He ate a few small meals and snuggled with me in bed, until my husband came to bed and pushed both of us over to the edge. heh Poor Toddy. :(

I am gonna go check on him in about an hour, then I have to head off to the airport. I feel so bad for the vet office, I left them a two page letter about what I THOUGHT Todd might need (more pain meds and IV fluids) and that he needs lots of love, treats and brushing. haha My husband told me I was going to offend them, but I am just a paranoid kitty mom. I am gonna pick up a couple dozen donuts for them as a thank you.

Anyway, I might not be able to update again until I get back on Monday. But please keep sending healing thoughts to Toddy. He needs it!

Thank you all! <3
 
There is some conflicting opinions about how fat in the diet can affect pancreatitis. I/D is 47% kcal from fat. Ideally you want under 35% kcal. Some varieties of Fancy Feast have low fat, such as the Elegant Medley varieties, which are OK for diabetics.

http://binkyspage.tripod.com/CanFoodNew.html

The IBD med you may have been told about was probably metronidazole. My vet prefers it over steroids for a diabetic.

Hope Todd's better by Monday. You're doing a lot of the right things. Sometimes it's finding the combination of right things that does the trick.
 
*UPDATE* So Now That We Know It Was Pancreatitis.. What is N

I got back home this morning and picked Todd up from the vet around 3ish this afternoon. He was vocal and bright eyed, but not 100% better. I called to check on him each day while I was gone, and they said he was doing great. They started him on Prednisone on Friday. One pill each morning. They are giving this in place of an appetite stimulant, and also to see if it does any good for him. They told me he was eating about a can to a can and a half of food each day over the weekend. They removed the IV last night and when I brought him home I gave him 50ml of Sub-Q. So his med list is now as follows...

Lantus 1/2 unit to 1 unit twice a day Depending on his BG numbers
Metoclopramide 1/4 tablet every 8 hours
Pepcid AC 1/4 Tablet twice a day
Tumil-K Potassium tablets 1/2 twice a day
Prednisolone 5mg Once a day

in 14 days, depending on how he is doing, we will slowly cut back on the Pred and see how he does.

He seems a little blah now that he is home. No doubt because the foster kittens are still here and he's probably pretty tired from the vet and car trip. But I have hope that he will soon start to recover. They said his weight has been staying at around 11 1/2lbs for a few weeks now, so I guess staying the same is better than losing more.

I do have a question for folks using Prednisolone on your diabetic cat with Pancreatitis.. about how long until you started seeing a REAL difference? As in, eating better, acting better, gaining weight and such. I doubt it will be instant, since they just started this on Friday. But I would love some input. I did have a cat that was on Pred just for IBD and he got better pretty fast, but Todd is a older diabetic cat with Pancreatitis, so I expect it will be different.

He has had some i/d to eat since getting home, and he is munching on his treats, which is good. I saw him grooming himself earlier which is nice to see. He seems a bit stiff when he walks, and I have to wonder if that is just because he was sitting in a kennel from Thur until today.

So they rechecked his blood work again over the weekend as well. His Kidney numbers look REALLY good. They are well within the normal range again. Here, I'll show you


This is just how it is written on the labwork:

Phosphorus 4.1
Bun 36
Creatinine 1.8
Potassiunm 3.7

Now, it also says this and I do not know what this means and I was unable to speak with the doctor about it.

It says:

Lipemia 2+, the following results may be affected by this degree of Lipemia

-INCREASE-
Lipase may be increased by 30-35%
Calcium may be increased up to 10%

I don't know what that all means. Anyone?... there are no numbers aside from the % given. I will ask the vet tomorrow though.

Thank you! :)
 
You asked:
Now, it also says this and I do not know what this means and I was unable to speak with the doctor about it.
It says: Lipemia 2+, the following results may be affected by this degree of Lipemia

-INCREASE-
Lipase may be increased by 30-35%
Calcium may be increased up to 10%

I don't know what that all means. Anyone?... there are no numbers aside from the % given. I will ask the vet tomorrow though.


It means that there us fat in the blood. If you looked at it would look a little milky. That condition of the blood can interfere with the analysis of specific constituents of the blood. Specifically, the measured Lipase (a digestive enzyme) and calcium may be measured as being higher than they really are.
 
Is this something I should be concerned about?.. what should I do about it?

The vet didn't say anything about it, so I don't know if that means we should worry or not.

Thank you!






Todd got all of his meds today and is still eating a bit. I am still hopeful that the Pred will kick in, but again, I don't know how long it takes for it to be effective at helping Todd gain weight and keep eating.
 
Just checking in and happy to see he is back home.
The question about pred is a tough one cause as you know ECID. Pedro has been on it for a while but I couldn't begin to give you any ideas as he on other meds and has othe issues too. I do know that even tho he still has his fPL test coming in at >50, he has gained weight and he is overall looking better in terms of coat and muscle. The last time we backed him off pred too soon and he relapsed really fast. But you and your vet will work out his reduction, too.
 
Re: *UPDATE* So Now That We Know It Was Pancreatitis.. What is N

ToddyTiger said:
I I do have a question for folks using Prednisolone on your diabetic cat with Pancreatitis.. about how long until you started seeing a REAL difference? As in, eating better, acting better, gaining weight and such.
Click to expand...

When Boo would have a flare up, we used dexamethasone shots instead of pred. he usually perked back up by that same afternoon. He finally reached a point where we just maintained him on steroids on a regular basis instead of using them occasionally. That was the single best thing that kept the pancreatitis in check. It also made his glucose numbers more stable. On steroids, he ranged from 80-250 over the course of a day. Off steroids, he could go up into the 500 range.

He was also one of the cats who could not tolerate a high fat diet. Keeping the diet controlled kept flare ups to a minimum.
 
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