At a loss with feline pancreatitis

[Nooglies]

Hi all,

I wanted to seek some advice, words of comfort or just general what to do in this situation. This will be a long read but I want to track every part of her unpleasant journey so far.

For context, early March, my 10(ish) year old female cat completely went off food. She ate practically nothing over a weekend starting Friday morning, and was moving very slowly (going down the stairs step by step vs. her usual sprint down for food) sleeping a lot and was generally acting really unwell. Saturday night, however, she suddenly perked up and was playing as normal and completely acting herself again, despite not eating still, but was back to her sorry self on Sunday. She went to the toilet as normal, all seemed okay there.

Tuesday comes and I manage to get to the vet. He initially couldn't find anything wrong with her. Bladder was empty, temperature normal, gums all okay, no signs of abscesses etc. She did vocalise when he touched her front paw and found it clicked when he moved it. But she didnt vocalise again when he moved it to indicate she was in any pain. Regardless, he diagnosed a sprained ankle and gave her some pain killers for the next 5 days and a shot while there. I had my doubts over this diagnosis as previously mentioned she was playing like a kitten on Saturday, running up and down the hallway and showed no signs of limping or pain in her paw/ankle.

Get her home and she immediately eats the bowl of food we gave her. Great - I thought - she must be feeling better! But Wednesday morning comes and she is eating more but still not with her usual ferocity. (She is normally like a vacuum, eating everything within 5 mins of the bowl being put down).

Finish the course of painkillers and though she was moving, playing and acting mostly normal - she was still really off her food. She would eat mostly the same amount as she always did, just it takes her almost all day to finish her first packet of wet food and all night to finish her second.

She then had a couple of days of diarrhoea and started eating grass to make herself sick in the back garden.

I had a Skype call with the vet who said her gums are healthy, her eyes look bright, no dehydration and she looks otherwise okay, but prescribed a sensitive food for her and some probiotics.

Unfortunately she would absolutely not eat the other food and hated the probiotics. We tried 50/50 and 25/75 of the new food and her usual food and she would not touch any food that wasnt her usual. If she smelled that other stuff, she would walk away. If we put it underneath, she would just eat a bit of her usual food of the top and leave the rest. We also had to force feed her the probiotics which was an awful experience. We noticed her really getting significantly worse having to do all this, and the force feeding of the pro biotics just made her avoid us and as a result would not come to her food bowl. We are obviously self quarantined currently so this wasn't great as she was pretty much hidden under the bed for most of the day.

As the time went on, I could see her eating less and less food. We stopped the sensitive stuff and tried to get her on her favourite -Sheba in jelly. She was managing maybe a 1/4 of an 85g packet a day. Less than half of what she had eaten. I became really worried. Finally got her in for another checkup, and a blood test. (Wednesday 15th April) They also said a fecal test was recommended. At this appointment she weighed 4.45kg. Her bloods came back normal and I was sent home with 5mg of Omeprazole to be given once daily. I was able to provide a fecal sample on Friday 17th April that we are still awaiting the results from. Over the weekend she made no improvement, even went downhill. Again managing maybe 20g of food a day at most. Called the vet (Monday 20th April) who got her in for another blood test (to be sent off to a lab this time) and an appetite stimulant and a steroid shot. She still did not eat anything. The blood test results were supposed to come back the following day, and the day after that, and the day after that. I called the vet again Thursday (23rd April) chasing the results, who called her back in. He checked her glucose and said she was fine, eyes were bright and she was alert so had no concerns. Part of the bloods came back on Saturday 25th April (god knows when the other part of these bloods are coming back) and apparently showed signs of pancreatitis. The vet wanted to have her in overnight, so we took her straight there. They also noticed an issue with her kidney readings but said that was likely due to dehydration and nothing to be too worried about. Overnight she had IV fluids and a cacophony of medications which I couldn't name as I quickly signed a waiver and was ushered out the door due to social distancing measures. They called late Saturday and said she was doing well, had eaten some and was showing improvement, would keep her overnight and we would get her Sunday. Today is Sunday 26th April and I dont know about what they considered improvement but she definitely seems absolutely no better than before. We got her home and of course - she wouldnt eat. She has been given some gastrointestinal friendly food, tramadol for pain relief, some more Omeprazole and some Forti Flora to go on food. She is extremely stressed. Her tail is tucked right under her legs and wagging, shes purring to herself too (trying to calm herself down). She has eaten a few bites of food but the vet seemed to imply she was eating just fine by herself. We just tried to give her the pills, as she refused them in food, we tried force feeding her them. That was a disaster that resulted in her gagging and nearly vomiting and foaming at the mouth, most of the pills disintegrated into nothing and was flung away in her drool. Now she has ran and hid under the bed with what looks like rabies mouth! How on earth am I supposed to get my cat the treatment when she wont eat what we put it in and is so difficult to force feed?

She's scheduled in to go all the way to Hull (1 hr away) for an ultrasound next week but currently all these vet trips seem to be accelerating a decline in her. I will keep a close eye on her but her weight has dropped half a KG in a week which worries me (she now weighs 4.05kg - down from 4.45kg Wednesday 15th April). I'm at a loss, if she won't eat she wont get better, but she wont eat because shes in pain, and because shes in pain she wont eat anything we put the pill in to counteract that pain. I'm truly at my wits end. We are nearly £800 in and with absolutely no improvement.

 

[rubysmama]

I just read your entire post, and unfortunately I don't have anything to offer, except words of comfort. I can only imagine how stressful this must be for you, especially with doing all this in the middle of quarantining and social distancing.

I hope some other members reply who may have suggestions/advice for you. Meanwhile sending hugs and healing vibes that your girl starts to feel better soon.

 

[babiesmom5]

I've been down the rocky road of Pancreatitis several times with different cats, so understand your stress. The most effective treatment for an inflamed pancreas is fluid therapy. In my opinion, while your cat was put on an IV overnight, (and supposedly showed some improvement), I do not believe it was long enough. It appears the cat has regressed, which they often do. I have had cats hospitalized for several days until they were well enough to come home. If this was my cat, I would take your girl to an ER as soon as possible to be put on an IV again. Along with the fluid therapy, they should also administer pain medication, anti-nausea medication, antibiotic, possibly B-12 shot and whatever else tests deem necessary.
I really don't think she is going to pull out of this on her own, thus I would have her hospitalized for a more sustained duration until she is fully recovered. I am thinking lots of healing positive thoughts for her!

 

[kittenmittens84]

As far as the pills go, have you tried a pill gun/pill popper? It’s basically a thin syringe with a rubber tip that can hold pills, they’re often very helpful for giving pills to uncooperative cats because you can get the pill much further back in the mouth than you can with your fingers, and then they can’t do the annoying store it in their cheek and spit it back up thing.

Alternately you might want to ask the vet if you can crush the pills in tuna water and syringe the liquid into her mouth. Some meds are really bitter (I think cerenia is) so it doesn’t work because it makes them foam at the mouth but others it works for.

 

[Nooglies]

Thank you everyone for your kind words and good advice!

Babiesmom5 - I completely agree. I do not think an overnight stay was nearly enough. A quick Google search said most cats with pancreatitis are hospitalized for 2 to 4 days on average. I believe the vet is (very unfortunately) stretched at the minute being the only local emergency vet still open in the area and so wanted to have her in for as short as time as possible. I will be contacting them tomorrow to inform them of the clear signs of regression she is showing.

Kittenmittens84 thank you for the advice! I might see if I can find a pill gun online for cheap and give that a go. I may try the tuna trick too - though like you said I believe one of the two pills is particularly bitter which was was caused the foaming at the mouth so I'm not sure if the tuna flavour will cover that up! I just hate pills in general - we've always had troubles getting them in her but normally ham or lactose free cheese is the trick. With pancreatitis though, all her favourite treats are strongly recommended against by the vet, and she wont eat them anyway so we are really at a loss. Shes had a lot of stress these past few days which I can only imagine is making her feel ten times worse, just wish I could flick a switch and make her all okay!

 

[babiesmom5]

Yes, most cats with Pancreatitis need 2-4 days or more on an IV. I have one sitting on my lap now that was at the ER on an IV for 2 1/2 days, supposedly doing fine, eating ok, so was discharged. Well, by next day, I could see that she had clearly regressed. My vet agreed. So rather than going back to the ER, the vet had me bring her in early morning where she stayed on IV all day, then came home at night. This went on for another three days before she was stable enough to come home. Some cats do take longer.

As for pilling, I use a pill gun, and encapsulate all her medications in a #3 clear gelatin capsule. You can even combine meds this way, or depending on size, cut them up to fit. It works well and lots less stress.

 

[neely]

Our cat was recently diagnosed with acute pancreatitis in March. He was not eating and acting lethargic so I got him into the vet the following day. We take him to a feline specialist who did a complete exam and bloodwork. We got the results by the next day. (He had an ultrasound for something else previously so she felt it was unnecessary to repeat.) I cannot pill him either so always request a liquid form of meds in a syringe. He was on Prednisolone, Mirtazapine which is an appetite stimulant, and Hill's A/D Prescription Urgent Care canned food. She was going to put him on an anti-nausea med but held off temporarily. Within a day he was eating and loved the prescription food but still showed signs of fatigue. We just finished weaning him off the Prednisolone but he recovered and is doing well. I'm writing this to give you hope and suggest looking into getting a second opinion if you feel the original vet did not treat and/or diagnose your cat satisfactorily.

Here are two threads with similar symptoms that may have some helpful information for you:
Cat has hardly eaten in a week and I feel like I am failing to assist feed
Possible Pancreatitis Elderly Cat

Please keep us updated about your cat's progress. We are all here for support.

 

[Nooglies]

Thank you for your lovely replies neely & babiesmom5. I will look into the gelatin capsules too! We have to give 2 half pills daily so one capsule would make it much easier. I believe the tramadol is incredibly bitter so hiding that in a gelatine case could help a lot!

Thank you for your story neely! I will be calling the vet tomorrow to enquire about some more treatment or hospitalization, I was surprised when they just sent her home with what they described as pain relief and an antacid. Seemed like an inflammation of the pancreas should require some more intensive anti inflammatory medication but I suspect they may have given her some while she was hospitalized (I barely saw the list of medications they charged me for before being ushered out!).

 

[LTS3]

If you can't find a pilling gun at the pet store, try some of these tips:

Pilling Cats: Must-know Tips For Hiding Pills – Cat Articles
The Best Pill-taking Secret I Know...
Pilling Cats and Dogs Safely
How We Give Our Pill Hating Cat A Pill
Getting Cat To Take Pills... Post Tips Here.

Ask the vet if he / she can prescribe a non-pill form of the medications. I know that both omeprazole and tramadol can be compounded into a chewable flavored treat among other forms. A local compounding pharmacy can do this

 

[Nooglies]

Thank you for the reply and links LTS3!

A little update, shes back in for another night of fluid treatment and IV medication tonight. I've completely maxed out my insurance for this condition so starting to become rather stressed by it all. Tomorrow first thing I'm taking her to Hull for an ultrasound, which I definitely cant afford. I asked about appetite stimulants today with the vet and she said she doesn't want to do any other treatments as we are unsure of if the pancreatitis is secondary to another illness that appetite stimulants could accelerate or make worse. In terms of pilling - the vet is going to provide a pill gun when we pick her up hopefully. The tramadol is the problem we have worked out. Its bitter taste causes her to have a horrid reaction (the drooling and frothing at the mouth). The Omeprazole is fine and doesnt have the same reaction. The vet does not think that the liquid version of it will benefit as it still has the same taste and therefore if we can try with the pill gun and get it right to the back of her throat she shouldnt taste it and avoid the horrible reaction. When we get her home tomorrow, I am thinking of confining her to the spare bedroom for a few days to de stress and hopefully being restricted to a room with her food would encourage her to eat. What does everyone think of this plan? Obviously she will have a litter tray, 2 beds, her food and a window to look out of. When she gets home from the vet she is always very stressed so want to give her a room to herself to acclimate, calm down, and hopefully enough quiet that she actually eats. Obviously we keep checking in on her often. I'm not sure if this will cause her more or less stress. When we got her back from the vet on Sunday she ran out in the back garden and hid in the shed for a good portion of the evening. Ideally want to prevent this from happening again but not sure if she will be aggrevated with being shut away in a room or appreciate the peace and quiet. Want to get everyone's thoughts on this?

 

[babiesmom5]

I am very glad to hear that you got your girl back in for another night of IV fluids, but I fear that one more night may not be quite enough. I would definitely rely on the vet's judgment as to whether she is stable enough by tomorrow to go for the ultrasound. If not, you might consider leaving her on the IV for a day or so more until she stabilizes. The other option if she is not quite stable yet, is to leave the IV pick in (well wrapped) for ease of hooking her back up again after the ultrasound. Talk it over with your vet.

Your vet is right about holding on the appetite stimulants temporarily. Those can be resumed once the ultrasound is done and after she is home and eating again. My cat was eating baby food chicken while hospitalized and I was advised to continue that when she first came home. After she progressed to her regular food again, I was advised to give the appetite stimulant.

I have not had much success with giving cats liquid medications, even flavored versions. I use a pill gun to the back of the throat. You could try a tiny dab of butter on the end of the pill which seems to mask taste.

As for where to put the already stressed cat when you get home, I think they do best with having access to their familiar spots. When mine arrive home from hospitalization, I let them out of the carrying case so they can look around and see that they are home. They usually run and hide under the bed. I let them stay there until they feel comfortable to come out and walk around, which they usually do after a few hours. We try to be quiet and limit noises in the house, but still hear voices, TV, familiar sounds for reassurance.

I guess I would ask you if she is familiar and comfortable with the spare bedroom? Does she go there on her own now? If yes, then this place might be a place of refuge and solace. If the spare bedroom is not someplace she frequents and spends time, then I think it (being a strange place) might add to her stress.
I would definitely not allow her go outside right away.

Thanks for keeping all of us updated. We are all rooting for your girl and sending positive thoughts!

 

[neely]

I've completely maxed out my insurance for this condition so starting to become rather stressed by it all. Tomorrow first thing I'm taking her to Hull for an ultrasound, which I definitely cant afford.

I'm so sorry, we shouldn't have to worry about financial costs when we are already under stress by our cat's health. I thought this TCS Article might have some helpful tips for you: No Money For Vet Care? How To Find Help And Save Your Cat’s Life

Regarding confining her to a spare bedroom - if you do that I would be sure to stay in the room with her and lay low, e.g. sit on the bed or floor, read a book. play calm music or talk to her in a soft voice to give her reassurance. Besides feeling ill she has been at the vet for treatment and will need you to comfort her. Or as B babiesmom5 suggested, allow her to have access to her favorite spots.

Fingers crossed that the ultrasound goes well tomorrow. Please keep us posted when you have a minute. Sending special thoughts and good vibes from all of us.

 

[LTS3]

The tramadol is the problem we have worked out. Its bitter taste causes her to have a horrid reaction (the drooling and frothing at the mouth). The Omeprazole is fine and doesnt have the same reaction. The vet does not think that the liquid version of it will benefit as it still has the same taste and therefore if we can try with the pill gun and get it right to the back of her throat she shouldnt taste it and avoid the horrible reaction.

Tramadol can be compounded into a transdermal (skin) gel if the bitter taste is an issue.

 

[Nooglies]

I just wanted to update you all to let know we have had to make the most difficult decision to unfortunately put Twinkle to sleep today. After the ultrasound today which showed she had an intestinal intussusception and an incredibly enlarged pancreas with no inflammation. The likelihood is that she has quite severe Lymphoma that has caused both of these. The surgery to correct the intussusception is £2-3k and that is just to correct the intestines. With her condition its likely the Lymphoma is very far along and chemotherapy would be in the thousands and give her maybe weeks or months. We are absolutely devastated and heartbroken. We think the time is right as she has been suffering for a month and has lost so much weight. She is in a lot of pain and discomfort and the vet has advised its probably the best solution as chemotherapy would be invasive and very expensive and likely not give her more than a few months. R.I.P my Angel. We love you so much xxxx

 

[babiesmom5]

Oh my, what sad news. My heart goes out to you with deep sympathy. I, and I am sure all here, are saddened at this very unfortunate outcome. While you are probably reeling and still in shock from having to make this painful decision, I do think you made the right decision to end her suffering. In light of the ultrasound results, and your vets advice, any further treatments would have been counterproductive and only prolonged her pain. Instead, you acted with the utmost compassion and love for dear Twinkle. She is at peace now, in no more pain, yet her love for you, and your love for her is eternal.

In time, and when you are ready, we do hope you will consider posting pictures and stories about Twinkle in the "Crossing the Bridge" forum. We all would love to see pictures and hear more about her life in her better days. You will find much support and comfort there from others who have traveled this difficult path.

Meanwhile, try to be gentle with yourself and know that you have many friends here. R.I.P Angel Twinkle.

 

[LTS3]

 

[Nooglies]

Thank you all - I will definitely post a lovely mention of her on the crossing the bridge forum - the difficulty will be finding a photo I love the most! In three years she makes up 90% of my camera roll! It was such a shock, and I feel like I've lost my bodyweight in tears, but she will live on in my heart for as long as I live. Xxx

 

[gilmargl]

Sorry that I couldn`t be of any help. I thought of you all day yesterday, driving to Hull and now so upset that the outcome was so devastating. But, you've definitely made the right decision. No pet deserves to have to put up with so much pain.
xxxx
RIP Twinkle

 

[rubysmama]

Oh no. I'm so terribly sorry.

RIP dear Twinkle.

 

[neely]

My heartfelt sympathies go out to you. Please take comfort in knowing that you did everything you possibly could and she fought a difficult battle. It was time for her to go to sleep and be painfree. RIP sweet and gentle girl.