Pancreatis

jarn

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Hi...so I have a lack of appetite thread, started Saturday morning, Timothy (former fat cat who will ALWAYS tell you he's starving) was disinterested in food. We noticed a broken upper canine. Supportive fed Saturday and Sunday, gave metacam. He was scheduled for surgery this Friday, but went in yesterday for a check and pre-op bloodwork. Went home with some more a/d and bupronorphine 2x/day. He has started eating on his own, but not his normal amount. I think we will syringe feed a bit again tonight.

He also has arthritis, but I don't think that's relevant. Gets fish oil and catrophen for that. Ordered some joint chews that haven't come yet. He's on 1x/month catrophen now. We didn't give it yesterday because of the other pain meds, but vet said it was okay to give today, so we will.

His bloodwork wasn't too bad, except for his pancreas. Over 2x normal. So he has pancreatitis. We are to supportive feed and give 100cc sub-q fluids daily.

Does anyone have an idea of his prognosis with pancreas values like that? I'm assuming that we're treating at home is a good sign.

One of our dogs (Neb, of course) had pancreatitis when he was young and had to spend 3 days in the ICU. One of our cats had it as well as some other stuff and we had to put him down. Not from the pancreatitis though. They said he needed a bone marrow biopsy and a transfusion, and as a very skittish semi-feral we didn't want to put him through that - vets and handling were incredibly stressful for him. So I have a mixed bag of experience with pancreatitis.

Timothy did have only diarrhea yesterday, but I thought that was due to the change in food/pain meds. Not sure now.

Complicating all of this, we've spent around $25k on vet bills in the last 5-6 years. We did not have that put aside. Most of the animals have insurance now but Timothy does not. Anyways, money is a consideration.
 

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jarn

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Thanks - we have about $13k space on my credit card, but the balance is already high, and our credit is fairly maxed in terms of what we can afford to take on new credit like that. We have a lot of debt brought on in part from previous vet bills. New pets we've got insurance on, but previously we didn't insure our pets, we have an account we put money into regularly for vet bills, but it's fairly low at the moment ($550).
 

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Pancreatitis is treatable. But you should have a clear game plan from your vet.

Some questions to ask:

1. How did this happen?
You might need an ultrasound to see if there is gut inflammation that spilled over to the pancreas. Although a tumor is rare, that's also something an ultrasound can rule out. What does he eat? Does he eat fish or dry food? Both of these are inflammatory and you may do well to reduce or avoid them. But if that's all he'll eat right now, then better he keeps eating and circle back to this later. It's better to eat well at McDonald's than starve at Whole Foods.

2. How do we treat this?
You can give supportive medicine to ease the pain and nausea and stimulate the appetite. But if you aren't addressing the underlying inflammation, how far does this go towards resolving it? Fluids are good here. But clarify with your vet what the overall treatment plan is.

3. How do we prevent this from becoming a chronic issue?
That goes back to #1. Right now, it's more important that he keeps eating and if fluids are prescribed, to give those as well. But as he feels better, you may want to consider the role of diet in preventing inflammation.

4. When should I bring him back in for a re-check?
You don't want to be too stubborn with home care with pancreatitis because it can do a fair amount of damage if not treated adequately. You can end up with a diabetic cat or one who doesn't digest his food well. Or he can develop hepatic lipidosis (fatty liver) if he's not eating enough. So how long do you give the treatment plan a chance before you bring him back in if you're not seeing him improve? And when does the vet want to re-test to make sure things are improving? Two weeks? One month? Don't assume that no news is good news.

BTW, my Krista had pancreatitis with 10 times the high range. For the Spec fPLI test, high range is 3.5 and her value was 35. I believe I have read somewhere that the magnitude of that number doesn't strictly correlate with the severity of the pancreatitis. She has had a couple of pancreatitis flare-ups since then. Both of those were correlated with dental pain causing us to deviate from her IBD diet. IBD flared up and spilled over to her pancreas. Once the problem teeth were extracted, she was much more willing to eat her regular diet and her gut and pancreas cooled off.
 
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jarn

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He eats Acana kibble. He's done well on it - he's not huge on wet food, but nom noms kibble. Where wet food is concerned, he's a picky eater.

I was reading about ultrasounds and how they don't always show anything. I think because of cost we'll hold off.

I was planning to ask the vet about cerenia or another anti-nauseant. We can syringe feed him but if he eats on his own that's preferred.

I also am going to ask about B12.

I do wonder how much of this was brought on by the broken canine. We started syringe feeding the night after he didn't eat breakfast - though for the evening and morning after he was getting baby food, which is very low cal. Our vet let us come in when they were closed to get a/d so on the second day that's what he was given.

He's been prescribed fluids, 100cc a day.

He was also a bit hypocalcemic (low calcium) so I'd like to ask about that. Just waiting to get the bloodwork.

I bug our vet all the time, so expect we'll be in touch regularly and will retest soon - we have one bag of sub-q fluids, so I was planning on talking to our vet about retesting when it's done (10 days).
 
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jarn

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Email I sent our vet (following up on the bloodwork):

"Also, if I can ask:

1) Would cerenia or another anti-nauseant be helpful? Or an appetite stimulant?
2) I’ve read some cats with pancreatitis are given B12? Would this help Timothy?
3) He’s had diarrhea yesterday and today too (and left butt shaped poop marks on the floor, poor guy) - is there anything we can use to help with that? Or will the buprenorphine perhaps bind him up a bit, being an opioid?
4) He’s eaten small amounts today and I think we are going to need to syringe feed him? How much a/d should we make sure he gets in a day?
5) When will we do retests? After the first bag of fluids is done?
6) What is his prognosis? (If you have any way of knowing that)

Thanks!
Jenn"

Hoping I've covered off the major stuff.
 

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There's something addictive in kibble that makes wet food a hard sell for most cats. Still, for his long-term health, it's worth trying to reduce or eliminate the kibble.

Fancy Feast Classic pates are very popular with even the pickiest cats. That was the go-to food for Krista when we had to deviate from her IBD diet to keep her eating. She would eat that food when her mouth was hurting too much to eat her normal food until we could get her latest dental issue fixed. But I've since learned that the fallout with her isn't worth it. Thankfully, her dental issues were resolved last year when I had her remaining teeth extracted. She was suffering through resorptive lesions for a couple of years. Every so often, her eating would slow way down and I'd have to convince the vet to take mouth X-rays and extract whatever tooth/teeth/roots were bothering her this time. Late last year, I took her to a veterinary dentist and said, "Make this madness stop! Make this the very last dental procedure she'll ever need." And we've not had any issues with her mouth since then (other than messy eating and food flinging. 😸 )

Another food that I imagine would have high appeal but never got to try with Krista because I already know chicken and egg are triggers with her is Tiki Cat's After Dark line.
 
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jarn

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When we first got him he was on wet food only (he weighed 23.4lbs, so was on a diet). We eventually moved to a mix and then kibble only. I'd rather avoid Fancy Feast... I have not heard of Tiki Cat, don't know if it's available in Canada - but we will peruse next time we're at the pet store! Thanks!

I had a former stray who came to me with 4 teeth left eventually lose them all and he didn't slow down with food one bit! He was neater than Krista though, heh. She sounds like a sweetie!
 

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I'm not a vet, but I can answer a few of those:

Cerenia would absolutely be helpful. It's even been demonstrated in a study or two to have anti-inflammatory action specifically in the pancreas.

An appetite stimulant can also be helpful. Especially because Cerenia can cause anorexia (loss of appetite) in some cats.

B12 would also be very helpful.

A probiotic might help with the diarrhea. Ask your vet about Proviable. That's one I've had good success with. Another option is sacchromyces boulardii, a yeast-based probiotic. It's discussed here with a brand recommendation (Jarrow s. boulardii w/ MOS):
My Cat Has Diarrhea - What Do I Do?
 
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jarn

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Posting at the same time!

I expect they'll agree to the cerenia. He's been on appetite stimulants before (mirtazapine? does that sound right? It's been awhile) (at times of stress - when he first came home and then after his best friend Lear died) and I think they'd be worthwhile now.

Oh I hadn't thought of a probiotic! Great idea! I'll check out that thread.

Thank you so much!
 

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When we first got him he was on wet food only (he weighed 23.4lbs, so was on a diet). We eventually moved to a mix and then kibble only. I'd rather avoid Fancy Feast... I have not heard of Tiki Cat, don't know if it's available in Canada - but we will peruse next time we're at the pet store! Thanks!

I had a former stray who came to me with 4 teeth left eventually lose them all and he didn't slow down with food one bit! He was neater than Krista though, heh. She sounds like a sweetie!
She had a recent surgery for an inner ear infection and was on activity restriction for two weeks. I set up a camera in her dog pen to check up on her without checking in on her. This is a pretty accurate representation of her eating.
https://thecatsite.com/media/solo-food-fight.423563/
 
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jarn

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daftcat75

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Posting at the same time!

I expect they'll agree to the cerenia. He's been on appetite stimulants before (mirtazapine? does that sound right? It's been awhile) (at times of stress - when he first came home and then after his best friend Lear died) and I think they'd be worthwhile now.

Oh I hadn't thought of a probiotic! Great idea! I'll check out that thread.

Thank you so much!
I like mirtazapine. I can give Krista half the prescribed dose and still get great effect. Plus her mirtz moments when it peaked with her were very adorable. I just had to be there to hold her while she meowed and purred until the initial rush passed. Then she would go to town on the food bowl.
 

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Sorry your kitty is ill. My mother’s cat had a severe case of pancreatitis last year and we almost lost her so I feel for ya.

When you say his pancreas came back abnormal- what exactly was abnormal? Many tests used for diagnosing pancreatitis are low in specificity thus really shouldn’t be used to diagnose pancreatitis (only to rule out pancreatitis).

I guess I bring this - up not to undermine your vet but since you didn’t really elude to clinical signs of pancreatitis (vomiting, nausea, lethargy, abdominal pain.) And with a broken tooth, I would expect a decrease appetite.

Don’t mean to give you more to think about, just wanting you to have all of the facts and that many vet clinic are still using amylase/lipase and some fPL tests that are only intended to rule out the presence of pancreatitis.
 
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When you say his pancreas came back abnormal- what exactly was abnormal? Many tests used for diagnosing pancreatitis are low in specificity thus really shouldn’t be used to diagnose pancreatitis (only to rule out pancreatitis).
It's one reason why I asked for the bloodwork - they called me as I was walking home from the dentist, so I was a bit off guard. I don't know what test they ran and I'd like to (also if he needs to into emerg after hours I have those results).

I'm not sure if he's more lethargic - he spends a lot of time sleeping at the best of times - but does seem more withdrawn. He IS having diarrhea.
 
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jarn

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So they did the Spec FPL test, which I believe is the sensitive one. They said we should see how he responds to treatment and then retest.

They're scripting out metronidazole and probiotics, and I'm picking up so gastro food as they think a/d is not ideal.
 
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We still need to syringe feed Timothy, but he's starting to graze on his own (normally he porks everything down, but still, it's positive). I'm worried he's not getting enough food, but he likely is.

My husband doesn't understand why, if all of this started with his broken canine (which happened somewhere between Friday night and Saturday morning), he has pancreatitis too. We started syringe feeding him (low calorie) baby food Saturday night and by Sunday were giving a/d. It just seems so weird.

But the vet apparently used the sensitive pancreatitis test, so he has it. We're concerned his eating will not improve while he has pain from his tooth. And that he might get an abscess or something. Is it completely impossible to do dental surgery right now?

I've called the vet to ask, she's in surgery at the moment but will call me back.

Timothy came into the bedroom last night - positive - but has barely left it today - not positive. He's on an opioid, so I suppose sleepiness is to be expected, but normally he's out on the couch and with the whole crew.
 

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I don't know why the vet would hold off on the extraction. My Krista had several extractions during a pancreatits flare-up. Her teeth were bothering her to the point where she stopped eating. I busted out food appealing enough to keep her eating. But it was also food that was triggering her IBD. Predictably, the inflammation spilled over to her pancreas. Surprisingly, it also spilled over to her liver. In her case, the teeth had to come out while she was also being hospitalized for the liver values (IV fluids and antibiotics mostly.) And for good measure, we got a feeding tube stuck in her neck so we didn't have to wait on her mouth and gut to cool off to keep nutrition in her. A feeding tube is always a fine option if you cannot get enough food in him via mouth (either on his own or by syringe.) But yes, I would definitely nail her down for an answer on why his teeth aren't being taken care of right now.
 
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jarn

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I've wondered about a feeding tube. I took care of some midday feedings that way for a friend's cat when they went to a race. The cat was not cooperative and escaped without the tube being flushed or closed, so I had to tear apart the bedroom to get her (literally took apart the bed) and got quite bloodied but did it in the end. That cat never liked me. Definitely doesn't now. I don't know why when you have a cat sick enough to need a feeding tube you go away, but whatever. I was supposed to be backpacking this weekend, but obviously am not, because I'm not leaving my husband to take care of Timothy on his own.

Yes, I think it makes sense to do his teeth. We are concerned his pancreatitis symptoms will be mimicked by his tooth pain and so we won't know what is what.
 

daftcat75

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The tooth needs to be dealt with as it can get infected. He might even eat more on his own when his tooth isn't bothering him such that the feeding tube won't be necessary. I'm also concerned that the inflammation in his tooth could be spilling over elsewhere. Usually, when Krista had a tooth issue, her liver enzymes would test high. I had many a disagreement with my vet whenever her liver enzymes tested high. I would tell her that I'd rather figure out where else the inflammation is and treat that first, then watch that ALT value go back into range. I'm not saying that's how it happens with every cat. I'm not a vet. But that was clearly Krista's pattern. Anytime ALT went high (and she wasn't on mirtazapine which can elevate ALT), it was telling me there was inflammation elsewhere that needed to be dealt with. So I wonder if the pancreas also responds to inflammation elsewhere like that. 🤔 I know with Krista it was always tooth pain lead to junk food to keep her eating which lead to IBD and pancreatitis flare-up.

Krista was a rock star with her feeding tube. I brought all the supplies out and laid them out in front of her--including the bag of treats--so she could see what was going down and what awaited her at the end. Then I squished her down into a comfortable laying position and she mostly laid still patient through it all. The only time she got squirmy is if I fed too much, too fast, or too cold. All three of them she gave me instant feedback so I could course correct. The only trouble we had with the feeding tube was the cap kept flying off whenever she shook her head. I got several extra caps from the vet and learned how to tape the cap onto the tube. If she flung one, I'd tape on a new one and go looking for the old one when I didn't have her esophagus open to the world.
 
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