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SaraMV

SaraMV

Member Since 2022
Taz has had a very rough week. He has pancreatitis and with each flare up, he seems to get a bit worse and it's harder for him to overcome and bounce back from them. We've also been having horrid humidity, which makes things worse and everyone miserable. We've been assist feeding him since last Monday.

Yesterday his blood glucose dropped and we had a hard time getting it back up, even with medium and high carb. Mostly because he wasn't willingly eating it on his own. We're lucky that we were home and able to catch it. Even though he earned another reduction (down to 1.5units), we decided to drop him down to 1 unit instead, because he's been earning reductions quite a bit over the last month, and we'd prefer for him to be a bit too high rather than to go too low when we're at work. I don't trust leaving medium carb down for him because he isn't eating on his own.

Today, he came out of the bedroom and was panting really hard. I thought maybe he was having a heart attack, and my husband and I sat with him, trying to soothe him and pretty much saying our goodbyes. It took us about 10 minutes to calm him down. I'm pretty sure it was pain related because he did the same thing the day he was diagnosed and we rushed him to the vet.

I've got him medicated on cerenia and bupe right now. I've been trying to give those to him sparingly because they carry warnings about the liver and he's already got an enlarged liver, but at this point I just want him as comfortable as possible. After he started breathing better, I offered him a little dry food (last meal type of thing) and he surprised us by scarfing it down like he hasn't ate in days.

So now we're confused. Do we offer him whatever he'll eat (he's pretty much been eating the same 4 flavors of LC since early January but doesn't like any of the other LC we've tried), or do we continue doing what we're doing in the hopes that we buy more time with him? We started giving digestive enzymes yesterday, but I don't know if they'll help at all.

What would you do in this situation? At what does it become quality of life versus quantity, and you give then whatever will make them happy? I'm struggling really bad right now with guilt because I feel like no matter what I do, I'm making things worse for him. It just sucks because we had the diabetes under control.
 
Oh Sara, I really feel for you. I totally have been in your place before… stupid post was posted by my phone and I have a lot more to say.
 
So, has he done any more panting? This is very concerning. I think you need to take him to the vet tomorrow if possible. Please try to count his rate of respiration while he is resting and preferably asleep. You can count with a thirty second timer and then double the result. Each rise and fall of his chest counts as one breath. You will hopefully get below 30 breaths per minute. If above thirty, I would take him to the vet - especially if he seems to be expending a lot of effort to breathe (sides moving a lot.). I am sure you know that open mouth breathing is an emergency and means that Taz needs to get to the vet.
 
If the panting was just a one time episode then maybe you are correct that he was just in pain from pancreatitis. I don’t know what to say about the food. He needs to eat obviously so you may want to feed him some different foods. But why do you think he’s on his last legs? Do you have a diagnosis from the vet other than the pancreatitis (well and diabetes obviously)?
 
He's semi resting right now. I just took his respiratory rate and he took 12 breaths in 30 seconds. He acts comfortable right now, and was interested in eating some medium carb about 2 hours ago (about 6 hours after the panting episode). The emergency vet is about 90 minutes from us. We were scared that if he was going to pass, that he would pass on the way rather than at home in our arms. Or if he was just in pain, that the added stress of the car ride would cause more issues. :(

Taz has an enlarged heart and liver. And also cysts on his pancreas. For all I know, one of them could have ruptured and caused the pain. We're still paying off the bill from his prior vet care (almost $10,000), and my husband just started a new job last week after being laid off in July. :(
 
What pain medication has the vet given you for pancreatitis flares? Also do you have fluids to give him and Cerenia and/or Ondansetron for nausea for a panc flare?
 
His respiratory rate is 24 which is quite good. It doesn’t sound like he’s in need of immediate veterinary care. I understand all about the bills as well. I very recently was confronted with a cat breathing very fast and with too much effort. Since she seemed stable and was not open mouth breathing, I opted to wait until the morning to take her to her regular vet. Turned out had a pleural effusion due to heart failure. So it worked out okay for us as we were able to get her stabilized, fluid removed from lungs and on medication- but it was a bit of a gamble. I was trying to avoid the ER at all costs but I would have taken her there if I had no other choice. I also had a cat that I chose not to take to the ER when I thought he was dying- for the same reasons you mentioned- he would perhaps have died in the car on the way and the whole thing would have traumatized him. As it turns out, he did die at home. It took quite a long time though. But I understand and am not criticizing you at all for your worries or your choices. However, I am hoping that this is not the end for Taz and that you will be able to help him over a rough patch. Much love and sympathy and empathy coming your way from one cat mama to another!
 
Suzanne & Darcy said:
What pain medication has the vet given you for pancreatitis flares? Also do you have fluids to give him and Cerenia and/or Ondansetron for nausea for a panc flare?
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We have ondansetron (I was giving it daily for about a month but he developed pale stools during that time and started losing weight. I suspected liver issues, so have been more careful about giving the meds unless absolutely necessary), cerenia, bupe, and gabapentin. The vet did not want to give us fluids for home, possibly because of the enlarged heart.
 
SaraMV said:
We have ondansetron (I was giving it daily for about a month but he developed pale stools during that time and started losing weight. I suspected liver issues, so have been more careful about giving the meds unless absolutely necessary), cerenia, bupe, and gabapentin. The vet did not want to give us fluids for home, possibly because of the enlarged heart.
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Yes. If my cat’s heart was not in tip top shape, I would not be giving fluids.
 
I was looking at your lab work last night to see if there was any indication of liver disease or other things that stood out - but the labs are not up to date. Has he been to the vet more recently? I hope he’s doing better today.
 
https://www.felinediabetes.com/FDMB/threads/making-the-decision-help-to-know-when-and-how.131915/

I feel for you, it's tough once you have so many competing issues and have to decide which to treat at the expense of others.

If it were me, I would medicate however he needed to get him pain free and eating on his own; because although there's the liver warnings, not eating can also progress to hepatic lipidosis pretty quickly. Additionally, the inappetence (and the flare itself) makes the diabetes harder to control, and risks ketones. To me the combination hepatic lipidosis, hypo, and ketones is the more immediate risk and I would treat those and worry about liver later.

I can't speak to fluids in a heart kitty, but I'm wondering if there is some sort of safe balance, you would have to ask vet if you think he's dehydrated.

The breathing is very concerning to me, as Suzanne mentioned. The last time Mr Kitty did that I thought it was a panc flare but was actually plural effusion and he had lost 80% of his lung capacity. If he's ok now then maybe it was just pain.

Yes - give him whatever he will eat, that is more important given the risks I mentioned above. Obviously, try to keep it wet, and as low carb as he'll eat.

I try to avoid leaning any which way in end of life discussions, unless it is abundantly clear that either (1) the cat is not ready to go and CG is being unnecessarily pressured by vets, etc or (2) the cat is beyond ready/suffering greatly and the CG is having a hard time letting go. See the link I posted above.

To me, Taz is in the middle ground. I always go with quality of life, and taking cues from the pet. If the flares are so frequent and long that he's just constantly in pain or nauseous, assist fed all day...that's no life for anyone. But if the flares aren't too bad, and in between those he's having a good life, then he has time.

I certainly understand the cost aspect as well. We are at the point we cannot afford another large ER or vet bill, so should something major come up we will have to put him down. I wish it were different, but we cannot sacrifice thousands for a cat when we have a family to take care of.

The only other thing I'd say is I personally have to have no regrets. Knowing I personally have done all I can within my limits (physical, financial, etc) and have given him the best shot at life, and the best care I could - while not losing sight of quality of life. It's hard enough losing a pet, it's worse when you live with possible regrets or doubts.
 
I can't weigh in one way or another, and can't speak to fluids etc., but I can share the situation I'm in with my chronic pancreatitis kitty Wicket. Last year he had yet another flare and became pickier and pickier about food, lost weight, would just sit in loaf position with a tense face all day... bupe would knock him out and reduce his appetite even further, so it didn't really work out for us. I was at the end of my rope watching him be painful like that every day, so with my vet we decided to go all in on quality of life, long term concerns be damned. We started him on gabapentin 25mg morning and evening (which I see you give as well), and that made a difference in his pain, but he still wasn't eating as much as he needed to. Out of desperation on a long holiday weekend I started him on 2.5mg pred once a day, just to see if it would make a difference. It did! He seemed so much more comfortable and eating so much better. I took him back to the vet and told her about my experiment, and she agreed that at this stage any concerns about pred toxicity were secondary compared to him feeling better on a daily basis. We have been on this regimen for almost a year now, he's back to his full normal weight and eating normally. Seems pain free except for the occasional constipation episode needing a little help.

I am not saying jump on the steroid train, but I do think with kitties who have so many concurrent issues and are no longer spring chickens, there's an argument to be made for giving them whatever makes them happier and more comfortable. In your case it could be giving pain meds daily to avoid breakthrough pain and feeding him whatever MC he will eat, and see if things settle. I am no expert in diabetes, but seems he could live comfortably with medium numbers?

In any case, I hope you find a middle ground that works for him and gives you more peace of mind. It's sooo hard to find that fragile balance in a way that, like Melissa said, allows you to have no (or minimal) regrets. Sending lots of good vibes for Taz!
 
Virginie said:
I can't weigh in one way or another, and can't speak to fluids etc., but I can share the situation I'm in with my chronic pancreatitis kitty Wicket. Last year he had yet another flare and became pickier and pickier about food, lost weight, would just sit in loaf position with a tense face all day... bupe would knock him out and reduce his appetite even further, so it didn't really work out for us. I was at the end of my rope watching him be painful like that every day, so with my vet we decided to go all in on quality of life, long term concerns be damned. We started him on gabapentin 25mg morning and evening (which I see you give as well), and that made a difference in his pain, but he still wasn't eating as much as he needed to. Out of desperation on a long holiday weekend I started him on 2.5mg pred once a day, just to see if it would make a difference. It did! He seemed so much more comfortable and eating so much better. I took him back to the vet and told her about my experiment, and she agreed that at this stage any concerns about pred toxicity were secondary compared to him feeling better on a daily basis. We have been on this regimen for almost a year now, he's back to his full normal weight and eating normally. Seems pain free except for the occasional constipation episode needing a little help.

I am not saying jump on the steroid train, but I do think with kitties who have so many concurrent issues and are no longer spring chickens, there's an argument to be made for giving them whatever makes them happier and more comfortable. In your case it could be giving pain meds daily to avoid breakthrough pain and feeding him whatever MC he will eat, and see if things settle. I am no expert in diabetes, but seems he could live comfortably with medium numbers?

In any case, I hope you find a middle ground that works for him and gives you more peace of mind. It's sooo hard to find that fragile balance in a way that, like Melissa said, allows you to have no (or minimal) regrets. Sending lots of good vibes for Taz!
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I'm so tempted to try this but I'm worried about his glucose with a steroid. I'm sp glad it helped your wicket though. Did he have any other health issues at the time?
 
SaraMV said:
I'm so tempted to try this but I'm worried about his glucose with a steroid. I'm sp glad it helped your wicket though. Did he have any other health issues at the time?
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He also has asthma (takes daily inhaled fluticasone for it), and we suspect he may have concurrent IBD/chronic pancreatitis, as it seems constipation and certain foods are the main triggers for his flareups.
It would definitely be a whole different decision tree if he had diabetes (although to be honest I am worried that he might develop it)... I am new to diabetes care, so I also don't know enough to know what numbers, while not being ideal for a cat's health, would be acceptable from a quality of life standpoint? Like, if you were to try prednisolone and it did (it might not!) improve Taz's daily comfort, what BG level would be acceptable in terms of quality of life? It's a delicate assessment, and like I said I don't know enough to weigh in on that.
 
I personally think most CGs are too hesitant to start steroids. If it is something that will help improve quality of life and there are no reasonable alternatives, I would do it. You just offset any changes with insulin. It does take some getting used to new patterns. Since he has liver issues, I'd be hesitant to use budesonide as it's harder on the liver (each steroid only works on certain areas of the body so budesonide might not even help...it's just usually the steroid of choice for diabetics since in most cases it does not affect BG).
 
This always sounds so negative, to me anyways. When a human or cat is in pain and doctors deny it that just infuriates me. It affects everything a cat does from not wanting to eat to not wanting to go up and down stairs to the litter. I've always had transdermal BUPE around the house even for temporary issues like Marco's UTI's to Daniel's megacolon issues. Maybe someone can confirm that transdermal BUPE doesn't cause constipation like an oral / GI tract BUPE would. It takes a few days to make up but it never affected Noah's numbers and even when I've quadrupled the dose I've never seen a cat tumble down the stairs.
Money and love are not the same thing, don't set yourself up for guilt you don't deserve.
I've known you long enough and well enough Sara to say that you know what you're doing and that you're your doing your best. Get him pain free and see what happens, he'll thank you for it. Wishing you all the best. :bighug:
 
SaraMV said:
Taz has had a very rough week. He has pancreatitis and with each flare up, he seems to get a bit worse and it's harder for him to overcome and bounce back from them. We've also been having horrid humidity, which makes things worse and everyone miserable. We've been assist feeding him since last Monday.

Yesterday his blood glucose dropped and we had a hard time getting it back up, even with medium and high carb. Mostly because he wasn't willingly eating it on his own. We're lucky that we were home and able to catch it. Even though he earned another reduction (down to 1.5units), we decided to drop him down to 1 unit instead, because he's been earning reductions quite a bit over the last month, and we'd prefer for him to be a bit too high rather than to go too low when we're at work. I don't trust leaving medium carb down for him because he isn't eating on his own.

Today, he came out of the bedroom and was panting really hard. I thought maybe he was having a heart attack, and my husband and I sat with him, trying to soothe him and pretty much saying our goodbyes. It took us about 10 minutes to calm him down. I'm pretty sure it was pain related because he did the same thing the day he was diagnosed and we rushed him to the vet.

I've got him medicated on cerenia and bupe right now. I've been trying to give those to him sparingly because they carry warnings about the liver and he's already got an enlarged liver, but at this point I just want him as comfortable as possible. After he started breathing better, I offered him a little dry food (last meal type of thing) and he surprised us by scarfing it down like he hasn't ate in days.

So now we're confused. Do we offer him whatever he'll eat (he's pretty much been eating the same 4 flavors of LC since early January but doesn't like any of the other LC we've tried), or do we continue doing what we're doing in the hopes that we buy more time with him? We started giving digestive enzymes yesterday, but I don't know if they'll help at all.

What would you do in this situation? At what does it become quality of life versus quantity, and you give then whatever will make them happy? I'm struggling really bad right now with guilt because I feel like no matter what I do, I'm making things worse for him. It just sucks because we had the diabetes under control.
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Im so sorry you and Taz are going through such a tough time. :bighug:
 
@SaraMV how is Taz? I see you have been getting a lot of good blues on only one unit lately, but how is he doing otherwise? I have been looking for a post from you, but couldn’t find one. And I have not been able to be on the Board much lately- but have checked in quickly from time to time and was thinking of Taz.
 
Thank you everyone for your replies. I have attempted to come back and update a few times but something always comes up.

Last Monday, apparently it was an isolated pain episode (scared the bejeebies out of us). He hasn't had another one since then (knocking on wood). He's had a couple of good days where he's wanted to eat on his own, but they were short lived, possibly because I started cutting back on the medication. We're still syringe feeding him daily (not all meals) to help supplement what he isn't eating on his own.

He acts hungry but he'll walk up to his food and turn his nose up to it. We went to the store and bought several different varieties of canned food and he's not a fan of them either. But the second he hears the dry cat food bag crinkle, he comes running. We actually tested that theory tonight. He refused his normal canned food but the second we dropped a few pieces of dry on top of it, he ate it and some of the moist he had refused a few minutes before. I'm pulling my hair out at this point because we know he wants to eat, he just doesn't want to eat what we're offering. So now, I'm thinking about trying a low carb dry food (as a treat to encourage eating) if there is such a thing.

I just feel so bad for him and I want him back to his old self sooo bad. But I also know that isn't going to happen and we need to appreciate the small glimpses of the old Taz when they happen. I thought about prednisolone for him, but then I worry about the side effects. It's like there is no winning because if we can help one thing, we jeopardize another.

I haven't been testing his glucose as much as I should be, because he's getting to the point where he cringes when he sees us coming, so I'm picking my battles. At this point, I'm less worried about the diabetes than I am about the pancreatitis. Diabetes feels like the lesser of two evils, and as long as he's within "safe high" numbers, I'm ok with that. He's not eating enough on his own to chance upping his dose too much, and with me working now, I can't chance him not having enough food in his system during the early part of his cycles. Those days with the lime greens scared us, especially that day where it took us 5 hours to get him to rise, even with high carb. I really wish I would have started TR a lot sooner, but it is what it is.

We did start him on some digestive enzymes. I don't know if they're really working, but even though his stool is still light colored, it is a lot less smelly. Maybe I'm not giving him enough of them, but I don't want to discourage him from eating even more. I wanted to try pancreatic enzymes, but I know those can cause issues if they aren't really needed.
 
Hi Sara. I’m glad he hasn’t had another episode of panting. I really would continue to give Cerenia daily as well as Ondansetron probably every 8 hours. If he’s nauseated as you describe his behavior to be - he’s just not going to eat. That behavior with the food is classic nausea. I have had cats who were on daily Cerenia for years. They needed it. First and foremost you need to get him eating again. He will continue to fade otherwise. I am glad you are supplementing his food by syringe feeding, but it’s really hard to give them enough calories like that unless you give them a lot. With regard to dry food, I would buy some Dr. Elsey’s clean protein kibble and let him eat it. It’s low carb. Just let him eat! You are at a point where you cannot be too picky about carbs. He must eat. Although if he will eat the Dr. Elsey’s dry, it would be great. I let Darcy eat quite a bit of that kibble before the end. He enjoyed it so much and it made him happy. No regrets there! I would definitely give Ondansetron too. Just watch out for constipation.


You mentioned Prednisolone? This may be another point where you cannot afford to be too picky. Will it raise his BG? Yes. But can you increase insulin if necessary? Yes. There are people on this Board who have had to give Prednisolone to their diabetic cats and they manage it. Usually there’s a bump after the pred is given during that cycle. Prednisolone is usually only given once per day. Have you spoken with your vet about this stuff? You really need to.

Oh, about the Cerenia- remember it is an important part of pancreatitis care for a lot of cats. Some cats with chronic pancreatitis must take it every day. It is anti inflammatory in the gut and can help pancreatitis a lot.

You can make him more comfortable and happy.

Big hugs to you! Thank you for the update. I was really concerned- but I checked his spreadsheet and saw it looked good. I think keeping him in those blue numbers is a very good thing.
 
By the way - as a Post Script to my message above, since you have been told he has an enlarged liver and you are concerned about it, have you been giving him a supplement to heal and protect his liver? I always recommend Denamarin since it has worked wonders for my cats livers - to bring down their liver enzymes in their bloodwork into the mid/low end of the normal range. It is a little pill. You can ask your vet about it. Many vets sell it (although I buy mine from Chewy because it’s cheaper.) If you can’t get a pill in him, then some Milk Thistle powder can be mixed with food and it is also healing for the liver. You could add it to his syringed food.
 
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