Help!! Beloved Cat Just Diagnosed with Pancreatitis/Kidney Failure

[iloveprincess]

My beloved Tigger was diagnosed with early stages of renal failure 3 months ago. He was on a crappy dry Iams diet, but after his diagnosis, I switched him to Honest Kitchen's Prowl, mixed with Wellness canned (Turkey formula). I also added a recommended renal supplement.

He seemed to be doing well, until he kept throwing up food/hairballs. It would happen intermittently, a few times a week. At first, I thought it was just a hairball, but when recommended hairball remedies didn't seem to work, I took him to the vet yesterday. The vet just informed me his fPLI level is 50 +. The vet said the cause is unknown and recommended an ultrasound to detect any possible tumor (nothing abnormal was felt during the exam). The only other option he recommended was prednisone. I'm just wondering A) if the ultrasound is absolutely necessary (I am an unemployed student and really can not afford $400 for an ultrasound). And, B), if those are truly my only 2 treatment plans? Aside from the vomiting and eating a little slower/less, he seems completely fine (his kidney levels were slightly more elevated than last time). 

I'm panicked about this since I LOVE my kitty, DEARLY. I have to inform the vet today of my decision, please offer your advice, anyone else that has been in this horrible situation. Is his diet okay and are there any other supplements I should start adding?

Thank yoU!!

 

[nwfn]

I am sorry you are in such a hard position. I was in your shoes recently with my cat Duchess (though not with kidney failure/pancreatitis), who passed away, so I understand the anxiety and guilt you may be feeling right now.

For me, it came down to what I would do with the information. If a tumor was located, what would be the next steps? In my case, I would have chosen between chemotherapy, putting my cat to sleep, or prednisone. If a tumor was not located, my option was still prednisone. So since I wasn't willing to make my kitty go through chemotherapy or put her to sleep at that time, the diagnostics would not have changed my treatment plan. Therefore I decided NOT to get an ultrasound.

So I would suggest discussing with your vet what would happen if something was or was not found with the ultrasound and decide from there whether it is a useful test for you to run in your situation.

 

[vball91]

The cause of pancreatitis is almost always unknown. I agree with nfwn. Talk to your vet about what would change with treatment if something was found on an ultrasound. How likely is a tumor or is the ultrasound just to rule out something?

Which renal supplement are you using? There are several options. With kidney disease, you want low phosphorus foods. There's a chart on www.catinfo.org that provides that info. Also, adding egg whites (either raw or cooked) is a good thing as well.

Many vibes for Tigger and hugs for you.

 

[iloveprincess]

Thank you for the replies, ladies! Your advice actually really helped me come to a final decision. I decided to bypass the ultrasound and instead spend my money on a treatment plan. Tigger is now on pred with injections of fluids and B12. Although the doctor said his case is severe, according to his lab results, he thinks Tigg can recover based on his symptoms. I am hopeful that he will make a full recovery. 

I did a bunch of research and realized that he was ingesting some potentially harmful substances. His renal medicine (Standard Process's Feline Renal Support) includes alfalfa, which I believe strongly is toxic to cats. I also learned that guar gum and carrageenan can irritate a cat with a sensitive system. I decided to discontinue the renal supplement and Wellness canned food (which contains both guar gum and carrageenan), in exchange of Nature's Variety duck formula. I'm keeping my fingers crossed. 

Thank you again for the replies, I was an absolute emotional disaster yesterday, and you both gave me a sense of peace about my decision. THANK YOU!!!

 

[dan32]

I had not heard of the iPLI test so looked it up.  Idexx Laboratories had this informative paper on the results of this test, its implications, and the validity of ultrasounds.  http://www.idexx.com/pubwebresource...es/feline-pancreatitis-roundtable-article.pdf

iLovePrincess: you would be amazed at how many people on this board have kitties with pancreatitis, IBD, small and large cell lymphomas - seemingly all related/overlapping diseases of the GI tract.  Many find relief with moderate doses of prednisone and/or changes to a raw diet.  You didn't say how old Tigger is.

Prednisone is sort of a miracle drug, however it has its own serious side effects long term.  Once you start on pred, you cannot abruptly stop it.  For this reason, people try and find the minimal dose to alleviate symptoms without doing too much damage.

I just lost my 5yo to suspected large cell lymphoma in the same general area of the liver, pancreas and duodenum.  Although he had been on death's door, he made a remarkable recovery with prednisone.

 

[iloveprincess]

I forgot to mention this before, but I'm SO TERRIBLY SORRY for your losses nwfn and Dan. Losing a beloved pet is no different than losing a family member, it is devastating! So sorry for your losses!

Thanks for the reply and the article, Dan, I will have to read it when I get a spare moment. I am nervous it says the test is not an accurate predictor of pancreatitis. Tigger just turned 11. His sister was Princess, and I am pretty certain she died from pancreatitis. She was never diagnosed, though, her death (organ failure in the course of one day) was a complete mystery. The vet never ran the fPL test on her. After educating myself about pancreatitis in felines, it sounds like this is what she had. I'm so grateful my new vet knew to test Tigger. 

I feel relieved reading about your limited success with prednisone. I'm truly sorry you weren't able to save your precious kitty, though.I will give Tigger his first dosage i about an hour. The potential side effects are frightening, I even discussed this with my vet, but he felt it was the best option for Tigg.  I actually read that prednisone is difficult for cats to convert, so prednisolone is usually the preferred course of action. I'm curious as to why your vet prescribed the less effective prednisone. 

 

[dan32]

All of these overlapping illnesses of the liver, pancreas and intestines are difficult to differentiate, even with needle aspirates or even biopsies.  Pancreatitis seems like an almost pre-c condition.  I was surprised there was a blood test for it.

I was having the pred made up into a chicken flavored suspension and the compounding pharmacy was using prednisolone.  Kinney had a very bad case of anemia (bleeding internally), and needed a transfusion so they could "prop him up" for his ultrasound procedure which revealed his (probable) large cell lymphoma on his duodenum, right where the pancreatic/bile duct dumps in.  The animal hospital had pronounced him a goner and offered up the pred as a last ditch solution to go home and try.  It was a total miracle - he was eating within the day.  What probably did him in was the chemo treatments, but I will never really know.

I read so many threads on this board of cats with GI issues being nursed along with prednisone.  5mg daily is a pretty standard dose, 10mg daily is a little high.   There have been some getting as high as 20mg daily, but that is probably dangerously high.  What was sort of neat about using the suspension was that I could give any dosage, even odd measurements that pills don't come in.  But 5mg is pretty standard.  That is what Kinney was getting and it acted very much as an appetite stimulant.

You could start to follow GoHolistic's thread of her Sebastian and his pancreatitis: http://www.thecatsite.com/t/264363/sebastian-is-back-at-the-vet-suspected-pancreatitis-again

 

[iloveprincess]

Aw, Dan, I'm so sorry to hear about your Kinney's tough battle. It sounds like you did absolutely everything in your power to help your kitty, so I hope that gives you some sense of peace. Your kitties are gorgeous, by the way. Which one is Kinney? 

Tigger is on a liquid form of prednisolone. 1 ml twice a day to start (for 2 weeks), then down to 1 ml once a day (for 2 weeks), then 1 ml every other day (for 2 weeks). I wish I knew how to convert ml into mg. Hopefully the vet is being conservative.

 

[dan32]

Thank you.  Kinney is the silver tabby in the photos.

The vial the medicine comes in will have the formula written on it.  Kinney's medicine was 20mg of pred in 1ml of suspension, so giving him .25ml of suspension = 5 mg.  The vial was marked 20mg/1ml.

 

[iloveprincess]

Kinney is absolutely gorgeous!!

Ok, so Tigger's medicine says 5 mg/ml-2 oz. Since he is getting 1 ml twice daily for 2 weeks, is that 10 mg a day? That seems kind of high, but he is a big boy at 16 pounds. Does that dosage seem safe to you for 2 weeks? He seemed great yesterday, but a little dazed today...

So, last night, Tigger leaked quite a bit of urine while he was sleeping. This has happened to him on a few occasions, but not enough to mention it to the vet. He is leaking quite a bit since I brought him home from the vet, though. I will call the vet on Monday. I wonder if it could be from the sub-q fluids? Is anyone aware of any diseases that cause this? He is not backed up with crystals (he urinates a lot). 

 

[nwfn]

Prefacing this with "I am no medical expert..."

I was researching prednisone/prednisolone when my cat was prescribed it. Apparently cats can handle this drug well, better than dogs or humans by body weight, with fewer side effects. My understanding is that they can usually be on it for weeks without problems. My cat was about 14 pounds when she was put on 10mg of prednisone (probably should have been prednisolone, don't know why they put her on prednisone instead, but I didn't know enough at the time to question it). So that dosage is in line with my own experience, for whatever that's worth, and I would tend to trust the vet's advice regarding medicine and dosage. (Nutrition not so much; I've had arguments over that topic before.)

No idea about the peeing though. You probably should ask the vet.

 

[dan32]

10mg a day should make a big difference in his disposition.  Once they level off and are doing better - sometimes they reduce it down to the 5mg.   5mg is considered a maintenance dose.  Kinney was at the beginning on 7mg daily, but he was only 8 pounds at the time.

Kin was a chronic vomiter - once he started on the pred, he never threw up again.  I had also switched my guys to a grain-free kibble at the same time, so I was never sure which one to credit.

 

[goholistic]

Hi there, iLovePrincess. 

I'm so sorry to hear about Tigger's struggles. 

  I've been following this thread from my phone over the weekend. I figured I'd sign in now while Sebastian's sub-q fluids are warming up.

Dan32 has already mentioned my Sebastian. He had confirmed pancreatitis 7/23/2013, and it was pretty severe. His symptoms were frequent vomiting, lethargy, pain. He was hospitalized for several days and had to be assist-fed for almost a week after he was home. He had another "flare" on 9/6/2013 (not necessarily pancreatitis this time but involved vomiting) and was kept overnight. He wouldn't eat on his own much that entire week and his diet has to be supplemented with syringe feeding. He was brought back to the vet on 9/13/2013. This is when we discussed biopsy for diagnosis for IBD or lymphoma assuming one of these was affecting the pancreas. I declined the biopsy so we moved forward with a novel protein diet (rabbit) and prednisolone. We started out at 7.5 mg daily, then 6.25 mg daily, then 5 mg daily, and then 5 mg every other day. After only a week on 5 mg every other day, he had another flare on 10/14/2013....this time it was almost as violent as the first in July, so we had to go back to 5 mg daily. He is still recovering from that flare, but is at least eating again. I also give him sub-q fluids at home every other day, as well as Pepcid AC.

Anyway, this is a very summarized version of what we've been through over the past few months. I can certainly relate to the "emotional disaster" part of it. Feel free to ask me any questions or follow my thread for updates on Sebastian (http://www.thecatsite.com/t/264363/sebastian-is-back-at-the-vet-suspected-pancreatitis-again/150).

 

[tammat]

My thoughts are with you ILovePrincess. It's awful to have a sick kitty. I hope it all goes well for you

 

[iloveprincess]

Thanks everyone for the replies and well wishes! It is very helpful to feel your support through all of this. GoHolistic, I truly appreciate you following Tigger's status and thank you for sharing Sebastian's story. I am keeping your little guy in my thoughts, as I know what you are going through. I hope you have found a good dosage for him and no flare-ups return.

Tigger is going on his 5th day of treatment. He seems to be doing okay, but it's honestly hard to say. I think he is feeling nauseous as he isn't eating very well and he lays in the bathroom, near the litter box. The vet told me to expect Tigger's appetite to increase, which I was afraid of because he already has a ravenous appetite. It seems his appetite has gone down. He has an anti-nausea medication, but the vet told me only to give it to him every other day. The vet also never called me back about him leaking urine, but that seems to have improved since the first day. 6 weeks is a long time for him to go through this and I hate not really knowing if it is helping or harming, or what is normal or not. 

Thanks for your support and encouragement!

 

[iloveprincess]

I don't know what to do. Tigger looks so sick today. He isn't throwing up or in the meatloaf position, he just looks ill. I have never seen him like this. I am debating whether I should give him his dosage of prednisolone tonight. 

 

[goholistic]

 
I don't know what to do. Tigger looks so sick today. He isn't throwing up or in the meatloaf position, he just looks ill. I have never seen him like this. I am debating whether I should give him his dosage of prednisolone tonight. 

Is he eating? Retreating in a corner? Maybe he's nauseous. Is he due for the anti-nausea medicine today?

 

[iloveprincess]

He did not eat dinner or breakfast. The first time in 11 years I've ever seen him turn away food. He was in the meatloaf position, which is scaring the crap out of me. I debated whether to rush him to the ER last night or wait until this morning. I simply can not afford further expenses, so I had to wait it out with him. Neither of us slept much. He is at the vet's now getting an ultrasound. PLEASE send positive thoughts to Tigger, I am so scared right now!

 

[goholistic]

I absolutely know how scary this is. When Sebastian was in the middle of a pancreatitis flare, the best treatment was supportive care - fluids, pain management, anti-nausea, acid reduction, antibiotics - as there is no immediate "cure." Withholding food and water for cats is controversial, but my vet opted to do this to give his system a rest. They closely monitored his liver enzymes. They did not prescribed pred at this stage, as pred could be contraindicated in cats with pancreatitis.

Sending many vibes that Tigger comes out of this soon! 

  

  

 

[dan32]

Usually cats perk up on prednisone.

I always gave Kinney his pred no matter what.  His was a suspension though, so no pills on an empty stomach.  I would syringe feed him something prior to his pred if he hadn't been eating.

Let us know what the ultrasound reveals.