Help Pancreatitis

Krista74

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My Himalayan cat Oliver had been diagnosed with pancreatitis about 3 weeks ago. It seemed to clear up after a week of meds and fluids but it's now back. I'm doing all the research but I still have some questions. He has been put on Cerenia (1/2 tab every 24hrs) and gabapentin (.75ml every 12 hrs) for pain however he still howls in pain and grinds his teeth. Why is the gabapentin not working? He's been eating a tiny bit and drinking a little. Tuesday I have him scheduled for xrays. Are the xrays neccessary for a possible obstruction even though vet didn't mention diabetes or any gall bladder issues? I know our kitties are our children and priceless... but in reality we've been to the vet 3 times (3 days in a row) and I've spent over $700. I feel horrible even asking if I should bring him in for the xrays. Or would skipping the xrays and scheduling an ultrasound be more beneficial? Of course I will do what's best for him.
 
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Krista74

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Btw Oliver is 6 years old.
 

FeebysOwner

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How was Oliver's pancreatitis diagnosed (Pancreas-Specific Lipase - fPLI)? And, what is anyone hoping to accomplish with x-rays, unless the vets are unsure of the pancreatic diagnosis? Personally speaking, I would ask the vet about why x-rays instead of an ultrasound. And, if his condition were confirmed with the fPLI test, I would also what purpose either of these additional tests will serve.

I have read data on Gabapentin that the effects do not last as long as 12 hours, so he may need to have the dose adjusted and administered more frequently. Also, is there any consideration for additional fluids? That may be part of his problem too. Has the vet mentioned the possibility of a feeding tube if Oliver doesn't pick up on his eating? They are very effective when treating certain cases of pancreatitis - plus a feeding tube also allows you to continue to try feeding him/giving him water by mouth.
 

hopscotch

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In my experience, you need to provide supportive care as well as address the reason it happened. I don’t think X-rays will show anything. An ultrasound will just confirm what the fPL test will confirm, that the pancreas is inflamed at this point.

Intensive subcutaneous fluid support is helpful while the event is occurring. Pancreatitis is dehydrating and hard on the kidneys too. Fluids help detox the pancreas I believe.

Did the doctor recommend anything else like a short term steroid for inflammation control, or a diet change? Diet (fat content) seems to be the underlying cause often. Sometimes they do antibiotics like a Convenia shot, just in case it was caused by an infection.

Gabapentin and Cerenia sound like just pain control and nausea control without dealing with the underlying cause. I would check with the doctor about how the underlying cause is being addressed rather than just treat symptoms.
 
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Krista74

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How was Oliver's pancreatitis diagnosed (Pancreas-Specific Lipase - fPLI)? And, what is anyone hoping to accomplish with x-rays, unless the vets are unsure of the pancreatic diagnosis? Personally speaking, I would ask the vet about why x-rays instead of an ultrasound. And, if his condition were confirmed with the fPLI test, I would also what purpose either of these additional tests will serve.

I have read data on Gabapentin that the effects do not last as long as 12 hours, so he may need to have the dose adjusted and administered more frequently. Also, is there any consideration for additional fluids? That may be part of his problem too. Has the vet mentioned the possibility of a feeding tube if Oliver doesn't pick up on his eating? They are very effective when treating certain cases of pancreatitis - plus a feeding tube also allows you to continue to try feeding him/giving him water by mouth.
HI FeebyOwner, thank you so much for responding! The vet did the pancreatitis test that was sent out to a lab and it did come back positive for pancreatitis. Not sure the name of the test. I wonder if it is listed on my receipt. He called the next day with the results. I'm wondering why the xrays would be needed if it's already been confirmed. I guess for a possible obstruction?? But I'm also very confused with vet terminology. Oliver also had a full blood panel done and just his electrolytes were low. I wasn't told if he has diabetes. Not sure if that was one of the labs... I'm just so confused. I've brought him to see 2 different vets. I'm just out of money and afraid to cancel the xrays for Tuesday. I'm scared that something else could be wrong. I don't know what they would find with xrays...
 
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Krista74

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In my experience, you need to provide supportive care as well as address the reason it happened. I don’t think X-rays will show anything. An ultrasound will just confirm what the fPL test will confirm, that the pancreas is inflamed at this point.

intensive subcutaneous fluid support is helpful while the event is occurring. Pancreatitis is dehydrating and hard on the kidneys too. Fluids help detox the pancreas I believe.

Did the doctor recommend anything else like a short term steroid for inflammation control, or a diet change? Diet (fat content) seems to be the underlying cause often. Sometimes they do antibiotics like a Convenia shot, just in case it was caused by an infection.

Oh yes, a diet change, thanks for reminding me. He put Oliver on the Purina pro plan E/N but Oliver keeps throwing up the kibbles. So I gave him some of my other kitty's food, Hills K/D and he likes it and kept it down. But no the vet has not recommended any short term care. Up until 3 weeks ago Oliver was healthy, so I thought...
 
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Krista74

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I've been keeping a journal of Oliver's feeding times, when he howls in pain (which seems to be about 15mins after he eats) and when I give him meds
 

FeebysOwner

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The x-rays probably would be used to detect something like a blockage, which may not be as easily detected with an ultrasound. The ultrasound would be done to identify changes in the pancreas and surrounding tissue in terms of inflammation. Again, get the vet to explain the purpose of each.

The glucose level, which should have been included on a standard Chemistry profile, would have been the best indicator of possible diabetes. Mild elevation wouldn't be deemed as definitive diabetes because things like stress can elevate glucose. Electrolytes can show up low with dehydration, and food intake will also play a role.

Follow up about more fluids and adjusting his pain meds.
 
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Krista74

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The x-rays probably would be used to detect something like a blockage, which may not be as easily detected with an ultrasound. The ultrasound would be done to identify changes in the pancreas and surrounding tissue in terms of inflammation. Again, get the vet to explain the purpose of each.

The glucose level, which should have been included on a standard Chemistry profile, would have been the best indicator of possible diabetes. Mild elevation wouldn't be deemed as definitive diabetes because things like stress can elevate glucose. Electrolytes can show up low with dehydration, and food intake will also play a role.

Follow up about more fluids and adjusting his pain meds.
So I should not cancel the xrays?
 

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So I should not cancel the xrays?
I would try to get some clarity from the vet on both tests. What are they looking for with the x-rays, and can the same things be identified on an ultrasound? What are the odds that an ultrasound is likely following the x-rays? You need to understand the vet's thought process so that you can make an informed decision. I can only guess what their thought process is.
 
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Krista74

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I would try to get some clarity from the vet on both tests. What are they looking for with the x-rays, and can the same things be identified on an ultrasound? What are the odds that an ultrasound is likely following the x-rays? You need to understand the vet's thought process so that you can make an informed decision. I can only guess what their thought process is.
Thank you so much, I appreciate your help
 

cylon.descendant

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Hi, I know your thread was from last month so not sure how things are going for you now. But just thought I'd mention what we did for my pancreatitis cat. We never did any x-rays (and I don't recall the vet bringing them up), but we did do two sets of ultrasounds about a month apart. The reason for the second set was because with the first set, the vet actually thought he may have pancreatic cancer (it turned out to be pseudocysts instead -- thank god!).

Anyway, for ongoing pain management, my cat is on gabapentin. I give it to him in liquid form and I believe it's a 50mg/ml formulation. To start, he got 1ml of that every 12 hours. When he had another flare-up and was showing pain again, the vet advised to increase to every 8 hours. When he was doing well again, we went back to 12 hrs. From what all the vets have told me, the safe dosage range of gabapentin is quite large, so if you need to increase the dose it shouldn't be a concern in that regard (talk to your vet about it, obviously).

When my cat is in a flare-up, we do a course of cyclosporine to help with inflammation (we do a 6-8 week course where he gets it once a day for a month and then once every two days for the rest; I imagine dosage and frequency may vary depending on the formulation you get). Some people do prednisolone, a steroid, instead (I think this may be more common. We just started with the cyclo when we thought cancer was a possibility, because I think prednisolone was contraindicated for that. The cyclo seems to work for my cat, so that's what we've stuck with). Anyway, the point is that in my cat's case, it has seemed important to have something to address inflammation during flare-ups, not just the pain management approach.

Finding a food that works for my cat is a whole other can of worms that has been quite stressful! He seems to have intolerances to a number of things. If you're looking into diet changes, I think there are a few posts around here about foods for pancreatitis cats.
 
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Krista74

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Hello Young cat. Thank you and appreciate your post so much. What valuable information! I'm so happy to know your kitty is not with cancer.

What great timing because Oliver was just at the vet AGAIN last night for another flare of pancreatitis or the same initial flare from Sept that never went away. I'm not sure. He was good for a few weeks, then all of a sudden he began throwing up everything he ate beginning this past Thursday. I was at the end of my rope again... I have gabapentin on hand thankfully but I was so concerned he needed an anti nausea med and fluids. My vet put Oliver on the Purina pro plan EN a month ago but I began to give him plain boiled chicken. He was still throwing that up as well. About 10 minutes after he would eat, everything came back up.

The vet I saw last night wouldn't give us any anti nausea med (Cerenia) and I was very upset, i didnt understand why. He said Oliver only lost a tenth of a pound since November 5th. (But since mid Sept he has lost 2 pounds). Anyway what he told me was to feed Oliver 5 or 6 times a day, very small meals. They also gave him fluids. That was it. I guess the reason why no Cerenia was because i had fed Oliver a very small amount of chicken a few hours before the vet visit and he kept it down. But that was the first time he had kept any food down in days. I was pretty upset he didn't give us Cerenia considering the holiday is coming and also it's like impossible to get an appt with any vets around my city, they are booked solid a month out from now. There must be a reason vets don't want to prescribe Cerenia? I thought it would have been nice to have it on hand in case of an emergency, but no, he said only if the throwing up continues. ??????? this frustrates me. He's been basically throwing up for 2 months! I have had to bring Oliver to the vet 5x now, have had to beg for gabapentin and fluids. I've spent close to $1,000. Cleaned my rugs so many times in just a 2 month timeframe. It's very redundant and tiring. I have never been so stressed and disappointed before. Not with oliver, it's not his fault.

So I guess the protocol is to feed him small, bland food 5-6x a day. If this doesn't work, we do an ultrasound. I better start saving my money for that. Can't imagine how expensive that would be. But we love our furry kiddos so much, we'd do anything for them.

Thank you again for reaching out, so appreciative.
 
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Krista74

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PS the vet continued to call my cat "she" even after the exam. Oliver is a he not a she. So I hope he knows what he's talking about.
 

cylon.descendant

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I'm so sorry to hear that your Oliver is in another flare-up! I know how stressful it can be and how upsetting it is to see them sick.

I totally understand why you're frustrated with the vet. When Smaug first went in for pancreatitis (we didn't know that's what it was at the time), he had stopped eating and had been vomiting a lot. It was an emergency vet that he saw, as they also did ultrasounds at that clinic. They were good in some ways, but really not thorough. They kind of just focused on addressing the pain with gabapentin and doing the tests (ultrasound, fine needle aspiration).

I was very lucky to be recommended an amazing vet by an acquaintance at the time. She helped me so much in terms of really thoroughly talking through how we might address the underlying problems. The emerg vet really thought it was cancer, but when she looked at the test results and ultrasounds, she thought that it was more likely to be pancreatitis related (and she turned out to be right). As such, she agreed that we should do something to try and help the possible pancreatitis while we waited for the follow-up tests a month away.

She takes a more holistic approach (she's not opposed to pharmaceuticals or anything, but she also looks at diet and things like that). So we spent a fair bit of time discussing diet — really limiting that to one food (that he would eat) so we could begin to suss out what foods he reacted to, since food sensitivities/intolerances/allergens seemed a likely factor in his case. We also talked about addressing the inflammation. That was why she prescribed a course of cyclosporine alongside the gabapentin. The cyclosporine ended up being something that helped, and with the diet changes and slowly trying a couple of different limited ingredient foods with different protein sources, we at least know certain things to avoid (and I think have an idea of something that works, though we're still figuring that out).

I guess the point is that if your able, talking to your vet about addressing the inflammation and not just the pain might be a good idea (or potentially seeing another vet that is a bit more thorough, if you can afford it). And it makes sense to me that you'd be worried about the vomiting as well. The kitty needs to be able to keep some food down, and if he stops eating eventually then that can get serious fast. When my cat initially went in he was given some mirtazapine, which is an appetite stimulant. But I guess that doesn't solve the problem if they can't keep anything down.

I hope that Oliver starts feeling better soon and that you're able to get the help you and Oliver need and deserve from the vet!
 

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I just saw your post and wanted to add my two cents. The above members have all given you very helpful information. I'm sorry that Oliver and you are going through this, not only the pain and worry but financial circumstances too. :hugs: Our Persian boy had two Pancreatitis flare-ups several years ago. The first one was worse and he did have an ultrasound which was very helpful. He was on Mirtazapine to stimulate his appetite and Prednisolone. I can't recall if he was on anything else for pain but I do know he was not on Gabapentin. The vet also gave us Urgent Care A/D cat food which he devoured:Hill's Prescription Diet a/d Wet Dog/Cat Food

We switched to a feline specialty vet approx.10 years ago when our regular vet retired and have been extremely satisfied. I know you mentioned all the vet visits and costs but you may want to consider consulting a feline only vet at some point if Oliver is not doing better. Sending special thoughts and healing vibes to Oliver and you. :vibes::vibes::vibes:
 
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