Pallina: Ibd And Pancreatitis - Advice Needed

[Antonio65]

At 6:30 pm we had an appointment with the ultrasound scan vet.
I had booked it yesterday after putting together some symptoms, signs and the last events. I feared it could be a CHF, so I called and the first time slot was today.

The scan vet did a complete exam of Pallina's heart, its structure and rate, blood flow and all.
He didn't find anything. Her heart is normal and perfectly working.
He couldn't find an explanation to what happened on Friday. He ruled out any heart involvement in the issue, he said that nothing came to his mind.
He also said that should it happen again we should put a Holter recorder on her and see what her heart does in 24 hours.

He suggested me to buy a basic stethoscope and start getting used to Pallina's heart beat when she's fine, so to compare it when/if something changes in moments like that on Friday.
A basic stethoscope is about €15-20, not too expensive.

Now we should feel better, no sudden surprises should pop out.

Thanks for your fingers and tails crossed!

 

[Antonio65]

Pallina isn't feeling fine yet.
In the last few days she hardly ate something, and if she did it was because I'm giving her half a pill of Cyproheptadine daily.

She's brighter early in the morning, but as the hours go by she gets slower and slower, and late in the evening she is just a poor cat.
As a matter of fact, it seems to me she gets worse as she is taking her morning meds. She starts fine and rather lively, she gets a bit slower after the first med (drops of Ranitidine), and a bit slower after her Metoclopramide, and so on.
This morning she didn't want to eat after taking the meds, even though 45 minutes earlier she was keeping an eye on her empty dish.

Yesterday I called her vet and he told me that nothing more than what we're doing can be done.
She's clearly in discomfort, and I think that during the day this discomfort turns into pain. The vet told me he can't give me anything to administer at home. They have a pain killer, but it can only be administered at the clinic because of the classification of the drug (Buprenorphine).
Unfortunately I do not want to move Pallina from home unnecessarily, she gets stressed out a lot lately and she takes two or three days to recover from a stress of this kind.

Yesterday I also noticed that her jaundice is getting worse. Her nose and belly are yellow!

She's taking 0.2 ml Ranitidine twice a day, 1 ml Metoclopramide 15 minutes later. She has her meal 30 minutes later. Then she takes a liver supplement twice a day, a Vitamin Bs supplement in the morning, 3 mg of Ursacol (similar to Ursodiol) at night.
Half a pill of Cyproheptadine in the morning, about 45 minutes away from all other meds.
I have just introduced a juice of Aloe Arborescens, Carrot and Honey (sold over here with the name of AloePlus), a juice for cats and dogs with lots of properties and that people talk miracles about.

She weighs 3.1 kg (on last Thursday), she lost 300 grams in a week from June 23rd to July 1st, then she gained 100 grams.
She would be supposed to eat at least 120 grams of her wet food daily, but now I'm thankful if she eats 80 grams.
Until two months ago she was at nearly 160 grams daily.

EDIT: Another vet at the same clinic told me that it's unlikely that Pallina would develop Hepatic Lipidosis, because HL only occurs in cats that have some fat on their body. This is the fat that liver turns to when a cat isn't eating. Pallina is rather skinny now, so she shouldn't develop any HL. What do you think of this?
Couldn't she be in HL already? What kind of test or blood levels could tell me if she has HL already?

We'll have a visit with full exams on August 6th. I hope she can hang in there for another 20 days!

Any suggestion will be more than welcome, thank you!

 

[artiemom]

((hugs))... no advice or thoughts.. just (hugs) and know that we are here for you...

FYI, I was told that thinner cats develop HL faster than chubbier cats. This was by 3 different vets.

Do not know the cause of the jaundice.. but it is very worrisome... if not HL, than what is it from?

Pallina really seems to be in pain. poor baby. I do not know what to say.. except that you are a wonderful, caring, devoted dad to Pallina...

 

[Antonio65]

FYI, I was told that thinner cats develop HL faster than chubbier cats. This was by 3 different vets.

Do not know the cause of the jaundice.. but it is very worrisome... if not HL, than what is it from?

artiemom , thanks for your great support.

Her jaundice could be caused by her very high bilirubine. At the test in May it was 1.93, the maximum level is 0.26, so she's 8 times higher than the max!
The Ursacol (Ursodiol) doesn't seem to be effective so far, or it just takes a longer time.
In 20 days time we'll know more, but meanwhile I need to have her to eat more.
I do hope that this new Aloe Juice is going to help her.
I bought it after reading many positive reviews from people with sick cats and dogs, and those pets were back to a very good shape in a few days.
I started on Monday night.

A couple of hours ago I called the manufacturer, they told me I can increase the dosage to a higher one. If it's too much the signal is the diarrhea.
I gave Pallina a slightly higher dosage last night and gave her a new dose this morning, even if the instructions say once a day.
Over the phone they told me to give a higher dose in one time, rather than two regular doses twice a day.

 

[mikameek]

Mika's bilirubin has been at 12 before. Her jaundice almost made her yellow. I am so sorry that Pallina isn't getting better but I think it's just a bit hopeful she's putting on a little weight.
It's interesting the differences between medications and the countries. Buprenorphine was given to me when Mika was really sick to help with her getting to eat (they thought her pain was keeping her). I still have it in my medicine cabinet.

Blood work for HL will be looking at liver enzymes and then an ultrasound to confirm. All the original liver enzymes that we've been looking (ALT, ALP, AST) will be checked for HL and then if they are higher, an ultrasound will look at the liver to confirm.

Mika was most definitely in HL with all her problems. It also took a really long time (like weeks) for me to see a difference with the Ursodiol. Are you checking her GGT levels? I don't remember from the original post but I'm curious since Ursodiol (Ursacol) helps with bile flow.

With the higher dose, I would just give her the higher dose at her regular time from now one. I did break the higher dose for Mika up between two syringes (we had it in liquid form) but we gave them at the same time.

Are we syringe feeding? Is she eating through the day despite feeling cruddy? If not, and I know its another thing to do, she needs to be syringe fed because calories are what stop HL. Kitten foods have higher calories so maybe start there and offer that normally. Then maybe offer kitten replacement milk. It has calories and nutrients but will be drank like water. Always try to get her to eat on her own and then syringe feed if she wont.

 

[Antonio65]

Mika's bilirubin has been at 12 before. Her jaundice almost made her yellow. I am so sorry that Pallina isn't getting better but I think it's just a bit hopeful she's putting on a little weight.

Hi mikameek ,
Thanks for your post.
Are bilirubin levels in US the same as we have here in Italy? Is 0.26 the max allowed?

It's interesting the differences between medications and the countries. Buprenorphine was given to me when Mika was really sick to help with her getting to eat (they thought her pain was keeping her). I still have it in my medicine cabinet.

In the past I was given some syringes with a pain killer to be used at home, but the firts one they gave Pallina at the clinic had her stoned for 36 hours, so we agreed to discard the other 4 syringes I was given. It was Tramadol.

Blood work for HL will be looking at liver enzymes and then an ultrasound to confirm. All the original liver enzymes that we've been looking (ALT, ALP, AST) will be checked for HL and then if they are higher, an ultrasound will look at the liver to confirm.

All her liver enzymes are high. I don't have the reports with me right now (I'm at work), but they were very high, over two times the max!

Are you checking her GGT levels? I don't remember from the original post but I'm curious since Ursodiol (Ursacol) helps with bile flow.

Yes, GGT is high as well, in three different tests it was between 8 and 12.

Are we syringe feeding? Is she eating through the day despite feeling cruddy? If not, and I know its another thing to do, she needs to be syringe fed because calories are what stop HL.

She can't be syringe fed because she fights a lot and gets easily stressed out, and she would hide for hours, and this would be worse!
She has IBD and is intolerant to many ingredients, so I cannot feed her what I want. I have to stick to a monoproteic food. Hence, no kitten food...
She can't be put under anesthesia because she has fluids in her chest and any sedation is a risk, so no feeding tubes either!

I'm going to try a different monoproteic food tonight. I just want to see if she's also bored with the same taste. She's been eating the same food for 15 months now.

I'll let you know

 

[mikameek]

Hi mikameek ,
Thanks for your post.
Are bilirubin levels in US the same as we have here in Italy? Is 0.26 the max allowed?

I believe they are close to the same? I was told that 0.5 was normal. But they might be slightly off because you said that at 1.93 she was jaundiced. I was told that 2 is where that begins for us. However, they don't seem to be that far off? I just wanted to convey that Mika hasn't even been close to the normal range for a VERY long time (almost 3 months). Her lowest bilirubin score since she's gotten sick has been 6.9 and we just recently got back close to it (7.0 right now).

In the past I was given some syringes with a pain killer to be used at home, but the firts one they gave Pallina at the clinic had her stoned for 36 hours, so we agreed to discard the other 4 syringes I was given. It was Tramadol.

Bup always made Mika INCREDIBLY stoned. I stopped her on it because it seemed like when she wasn't in pain, it just made it to where she was too drugged out to even eat.

All her liver enzymes are high. I don't have the reports with me right now (I'm at work), but they were very high, over two times the max! Yes, GGT is high as well, in three different tests it was between 8 and 12.

Again, we may have differences in the measuring between countries. Mika's levels have all been incredibly high too. Are the liver supplements you mentioned milk thistle? Have you seen if Pallina can take a liver protectant such as Denamarin (I don't know if there is a name change between countries, but Mika's levels all dropped very nicely while on Denamarin).

She can't be syringe fed because she fights a lot and gets easily stressed out, and she would hide for hours, and this would be worse!
She has IBD and is intolerant to many ingredients, so I cannot feed her what I want. I have to stick to a monoproteic food. Hence, no kitten food...
She can't be put under anesthesia because she has fluids in her chest and any sedation is a risk, so no feeding tubes either!

I'm going to try a different monoproteic food tonight. I just want to see if she's also bored with the same taste. She's been eating the same food for 15 months now.

I'll let you know

I'm so sorry I forgot about the IBD, you're right. I would definitely look at changing the protein to see if she's just been getting bored. Mika got VERY picky about her foods when she got sick. We're still kind of in a struggle to find foods that she'll eat well and consistently. I wish I had more advice on this, I'm so sorry. Please keep us updated!
If I can help you with anything at all, please let me know!

 

[artiemom]

OMG!!! I GOT IT CONFUSED!!!

I should have written..

CHUBBIER CATS GET HL FASTER THAN THIN KITIES!!

that is what I get for not having my complete cup of coffee, BEFORE posting....

Sorry....

 

[hxmoyu]

I had one cat with severe pancreatitis and another one with a sudden case of liver issues, they were both extremely sick and almost didn't make it. Neither of them would eat on their own so they were both syringe fed, the one with liver problems for about 2 weeks and the one with pancreatitis for almost 3 months.

Aside from very little medication, the vet suggested I give them both milk thistle (sold as sylibum marianum where I'm from), it didn't cause vomit for either of them and actually helped a lot, it's what contributed to both of them getting better and they are now very healthy. Other than that, the vet also gave me some drops made by a vet in Mexico from natural supplements and herbs for different diagnosis, I've used the ones for pain, hepatic problems, respiratory issues and digestive problems, all with great success. The hepatic one I used has: chelidonium, calendula and crataegus. She also took another one made for renal issues and gallstones, which has: yumel extract and zarzaparrilla (smilax aspera).

My cat with the hepatic issue took one pill (can't remember what it was for) and the natural supplements only, she was back to her old self in 3 weeks and started gaining weight quickly (she'd lost half her weight before that). I hope this is of some help to you, it looks like she's already on some medications but an extra natural helping shouldn't hurt.

 

[Antonio65]

Last night Pallina was hospitalized again, the third time in 19 days!

On Wednesday I had tried a new food, 100% mono-proteic, with high quality meats rated for human use, by an Italian manufacturer.
When I offered this new food (100% Goat) to Pallina, she yelled and jumped on the table like a hungry kitten. I hadn't seen such a reaction in years!
She gobbled down the portion I gave her, and she wanted more and more.
At last she was eating like I hadn't seen in a couple of years.

I gave her the same thing on Thursday, then I went to work, but when I came back home there was vomit on the floor, so it was clear that this new protein wasn't fine for her stomach and IBD.
I had bought a different meat (100% Rabbit).
Both meat were new to her, she had never had them before.

She showed no interest in the new food or in getting out in the courtyard either, she lied in a corner in the room, then she moved to the other room where she hid, lying flat on the tiled floor.
This was the sign that she wasn't feeling right, so I picked her up and took her to the clinic.

The vet did an X-ray that found lots of hard stools in her colon, along with two tiny spots of something that looked like bones fragments or a mineralized substance.

The vet gave her an enema, she produced a small amount of hard poop, the vet said that the rest was going to come later on.
She was put in a cage on an IV drip with Cerenia and other meds.

For the first time since the day she fainted (July 7th) she meowed and purred at the clinic. And her nose, that was yellow before leaving home, was pink at the clinic!

I will have new later this morning (it's 8:30 am of Friday here) and I'll visit her later in the afternoon.

 

[hxmoyu]

The vet did an X-ray that found lots of hard stools in her colon, along with two tiny spots of something that looked like bones fragments or a mineralized substance.

The vet gave her an enema, she produced a small amount of hard poop, the vet said that the rest was going to come later on.

This sounds exactly like what happened to my pancreatitis cat, Gorda. She stopped eating first, started drinking lots of water and looked to be in pain, she'd also lost some weight. When I took her to the vet the x-ray showed a lot of hard stool throughout the intestine, the enemas only got a little bit of it out and the vet had to perform emergency surgery the next day. Turns out there was a hairball blocking everything from going in and out all the way, the vet had to squeeze the intestine to get everything out (there was a quite a lot). Gorda developed the pancreatitis because of this.

As for the bone fragments, could it be the food she is eating? A couple of months ago I noticed that the food I was feeding my cats had shards of bone, some really tiny and others almost 1cm long, the smaller pieces were harder and the bigger ones were slightly softer but still strong enough to possibly puncture something. I contacted the food manufacturers and I was told they must be fish bones, which are apparently found even in non-fish based foods. I tried different food brands after this and found out that unfortunately quite a few of them had bone fragments as well, all within the same time frame so I'm not sure if it's a quality control issue going around right now.

When I first found about it I searched online and found several complaints from people finding bone fragments in cat's food, one person even had their cat rushed to the vet because of many bone pieces stuck in her abdomen, a huge health concern in my book. Make sure to check Pallina's food for bone pieces, you don't want to complicate her health problems with this. I'm blending all cans of food now to avoid this problem.

 

[Antonio65]

Make sure to check Pallina's food for bone pieces, you don't want to complicate her health problems with this. I'm blending all cans of food now to avoid this problem.

Thanks for sharing your experience!

Yesterday I went to visit Pallina at the clinic and took the fragments of bones with me so that the vets could examine them, and they told me that they were actually bone fragments. They told me that they were too small to cause any harm and that probably they were part of an intended food processing in order to add minerals to the food, though I think that if this was the manufacturer's intention, then why not to reduce them to powder?

I always mash the wet food I give to Pallina with a fork. I always add some fresh water and some psyllium seeds to the wet food, and then mash it. This way any foreign object should stand out. I can't understand how I could have missed them.

I talked with clinic an hour ago and they told me they are going to release Pallina in a couple of hours.
She's very fine, eats everything they give her except the food I took from home for her!
She never puked, no matter what they gave her, not even with the food she's intolerant to.

They adviced me to feed her small portions more times a day, and when I can't be there all day long, the best solution is a timed feeder.
Looking on the web, though, these feeders might be unsuitable with wet food...

Anyway, I'm going to collect Pallina in a short time, I will let you know

Thanks to everybody!

 

[Antonio65]

Pallina is home again. But it seems nothing has changed...

When I went there yesterday I found her lively, happy, loving. The vets siad she had eaten everything they gave her, with a good appetite. Just as she had done the day before. Just as they told me over the phone on Friday and Saturday morning.
She was meowing and purring to everybody.

The minute she came home, she became lethargic again. She is hiding, not eating.

I think she pretends to be healthy when she's at the clinic because she knows it's the only way to get out of there.
And when she's here she shows the true conditions.
In this case she would be smarter than the vets. I tried to explain them that what they were seeing at the clinic wasn't what I was seeing at home, but they prefer to believe what they see.

Or I think she dislikes us and is happier at the clinic.

Until a few weeks ago her main interests were food, sneaking outside as soon as she had the chance, staying outside as long as possible, lying on the window sill looking outside, staying with us on the sofa at night when we watch the TV.

Now, she is not interested in food anymore, no matter what food (at the clinic she was eating just everything!), if all doors are left wide open she just walks back and hides, if taken outside she tries to go back inside as soon as possible, the window sill is absolutely no more interesting, at night she rather stays on a chair, possibly away from us.

She's not meowing or purring anymore since the day she fainted, but at the clinic she was meowing non-stop and purring loud!

I'm exhausted! What's wrong with her?
Should I surrender her to the clinic and leave her there for good?

 

[PushPurrCatPaws]

Was she given pain meds at the clinic? I know you said they wouldn't give you any pains meds for her for you to give to her at home (buprenorphine), but I guess I don't understand this. It does seem to be the difference between her comfort level at the clinic, and how she is at home? Even considering its classification, our vets here in the US can prescribe this med for home pain relief for the cat.

 

[Antonio65]

Was she given pain meds at the clinic? I know you said they wouldn't give you any pains meds for her for you to give to her at home (buprenorphine), but I guess I don't understand this. It does seem to be the difference between her comfort level at the clinic, and how she is at home? Even considering its classification, our vets here in the US can prescribe this med for home pain relief for the cat.

Pallina was put on some meds when she had the IV at the clinic, what I know is that they gave her Cerenia and Buprenorphine.
This is, apparently, what was keeping her perky at the clinic, and when she is home the situation goes downhill.

Yesterday at 5 pm she was hospitalized again. This time I went to the University Hospital, where they ran a blood test right away, and a complete scan of chest and abdomen.
She had a downturn in the early afternoon, she was irresponsive, I was scared!

I haven't the full report with me as yet, but I was told that her bilirubin has gone to 4.3 (it was 1.93 two months ago).
They are going to keep her at the hospital for a few days. They told me they were going to put a nasogastric tube to force feed her. They will also run some more tests today.

The blood test was what I had asked my vets to do since the first time she was hospitalized on July 1st, then again on 6th and on last Thursday night. They always said thay would, they never did.
If we had known of this altered situation a few weeks earlier, we could have taken the right countermeasures to fight the problem...

I will call the hospital in about an hour time, I will be able to visit her after 6 pm today (it's 11 am right now here).

 

[PushPurrCatPaws]

I am so sorry you are going through this. This is such a struggle and downright scary, I am really praying and hoping that she can hang tough and improve. My heart is with you
Pallina

 

[artiemom]

just ((hugs)) and love.....

 

[Jojo&Tutu]

Sending you prayers for Pallina's recovery. My kitty Tutu also IBD, chronic hepatitis and chronic pancreatitis. This is called triad disease. Lately her IBD and liver are ok but her pancreatitis is two years out of control. Her pancreatitis might be affecting her kidneys as her BUN recently jumped to 60. She is in stage 2 kidney failure but her BUN ranged in the 40's typically in the past. She had a rare benign liver tumor removed in 2016 and had I131 treatment for thyroid adenoma last spring. (I think we communicated a bunch about it and I thank you for your support.) Tutu had 7 teeth deteriorating removed surgically last month. Her vet has said no more teeth surgery as anesthesia is a risk for her age and condition. Since the teeth removal she has been eating more and gaining weight but she has had a recent setback that I will explain in a bit. My internal medicine vet has been in practice decades and is a former professor at UC Davis. She was off for a while with her own family crisis but is back. She tends to be overly reactive but I do trust her judgement in the long run. Here's a few suggestions that truly helped Tutu and might help your kitty. With IBD it is recommended to stick with one unique protein diet. Once you find one formula that works stay with it with no variance. The variance causes IBD flare ups. If you find one the cat likes to eat without many reactions stay with it: Rabbit, or Venison for example. If she vomits it can be pancreatitis or IBD. Maybe don't worry about the occasional vomit and give her what she will eat. This prevents fatty liver failure. Most important to keep her eating. I tried to find a unique protein with no carbohydrates added. Sweet potatoe and green pea made Tutu sick. Another suggestion is: Try blood allergy testing. There are a few companies that do so in the U.S. This will direct you as to what carbs and proteins to avoid. Some vets think blood allergy testing is not accurate but I had skin allergy and blood allergy testing on myself years ago and they matched. Tutu's blood allergy testing also matched my observations of how she reacted to different foods. I believe in the value of this testing as it can give you a direction of what foods to avoid. Another thing to avoid in foods are the additives like guar gum, carrageenan, xanthan gum and other similar gum additives in food as they can cause inflammation that can worsen IBD. As for constipation: Try Ondansetran (Zofran). This has been a miracle drug for Tutu. Tutu takes one half of a 4 mg (2 mg) Ondansetran (Zofran) tablet in the morning before eating. This relaxes the intestinal muscle and helps her bowel movement. It also helps with nausea like Cerenia. The Ondansetran has made a huge difference in constipation issues. I used to use Psyllium husk but that dried her stool and added to constipation. I also add organic pumpkin baby food for constipation. I am down to 1/2 teaspoon per 5 oz. can of cat food. (Very little). When Tutu doesn't poop she won't eat. So it is important! Also I can't quite remember why but Ranitidine was a problem for Tutu. Her vet had her switched to Pepsid AC 2.5 mg (1/4 of a 10 mg )(lowest dose) tablet twice a day. This worked best. In the morning Tutu takes Ondandatron and the Pepsid AC before her meal. In the evening she takes the Pepsid AC before her meal. After her dinner she also takes Budesonide .4 mg and Amlodipine .625mg. Budesonide is a steroid mostly affects the bowel without affecting other organs. The Amlodipine is for hypertension ( a little elevated blood pressure). I have a local compounding pharmacy compound these each into a tiny capsule. Easy to swallow and does not add another food to it like liquid compounding does that can cause flare ups. I also add a little renal potassium powder into her food as she is a little low on this. Tutu is a small framed Siamese Balinese cat just about 6 lbs and 7ounces (about 6.5 lbs.). Tutu was on Clavamox antibiotic for pancreatitis long term but it never got rid of the pancreatitis. Some say antibiotics can cause pancreatitis to worsen. When on a stronger antibiotic the pancreatitis goes away but she quits eating somewhat and then a week later the pancreatitis comes back. Her pancreas is in nodular hyperplasia. I'm not sure that a stronger steroid wouldn't cause more bacterial overload ?? It would be interesting to find out about the Pancreatitis research mentioned. What my vet Cindy recommended for Tutu was sub Q fluids -100 ml sterile fluid in the morning after eating. This is put under her skin on the top of her neck. It is supposed to help pancreatitis and the kidney issues. This might have to be done long term. If anyone has any other suggestion for pancreatitis please let me know. Tutu will be 16 next month but I'd like to keep her around a few more years. Ive also been thinking about Pallina's screaming and not peeing much and I wonder if she could have kidney stones or some blockage affecting her urine flow and maybe the constipation is painful or the full bowel is pressing affecting her urine flow. Tutu used to cry out with a bowel movement or even throw up after. I think her bowel movement would cause spasms causing the throw up. This has subsided with the Ondansatron use. It is not as painful. I also want to mention that I believe the increase of radiofrequency and harmonic exposures in our environment due to smart meters in gas water and electric lines and the increase of cellular RF in the environment is contributing in a major way to biological inflammation in our and our cats health. See: NTP.niehs.nih.gov cellular cancer study on rats and mice, BioInitiative.org (or.com?) and saferemr.com for an excellent overview. Well, sorry for this long novel but I'm hoping this helps you especially since you helped me very much with the I131 treatment decision and process last year. Thanks again!

 

[Antonio65]

Jojo&Tutu ,
thanks for your long and informative explanation. It seems you are devoting very much for your lovely and beautiful Tutu.
That's the way to go, love and tender care make our cats live longer.

Thanks also for the suggestion for treating Pallina, but, sadly Pallina isn't with me anymore, since August 8th.
She had to fight against the unknown and the ignorance and incompetence of the vets. I have lost her, and now my life is pointless and void...
I do hope I've done all I could for her. I'm broke...

Her story and her fights are told in this thread
Pallina, The Cat Who Went To Belgium

Thanks again, I wish a very long life to Tutu!

 

[mani]

Out of respect for the lovely Pallina, we will lock this thread.

For Pallina's tribute thread, please go to
Pallina, The Cat Who Went To Belgium



..............................................RIP precious Pallina
.......................................* * * *



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