Pancreatis

[jarn]

Well exactly. We are worried about infection/abscess, we're worried it's the tooth symptoms causing him not to eat and would this make the pancreatitis worse? Are we confusing symptoms between the two issues.

The good news is Timothy's liver values aren't high (actually slightly low, which the vet said was not a concern). So there's that at least. When Neb had pancreatitis it took months and a low-fat diet for his values to go to normal.

Yeah when I was tube feeding my friends' cat, I warmed the food, gave a small amount at a time, etc., - but she doesn't like me and was feeling better so fought me. I was supposed to go in for two feedings, but after the first disaster there was no point.

 

[jarn]

Email to our vet - they are slammed so will call me later, but gave me a handout on pancreatitis in the meantime:

"Thanks. Toby is confused about some stuff and I didn’t know what to tell him.

-Why did the pancreatitis develop at the same time he broke his tooth? His diarrhea symptoms only started after we began syringe feeding/switched his food. He is more lethargic/withdrawn but he’s also on an opioid. And not feeling good (could be the tooth alone?). He’s not vomiting. Starting to eat a bit on his own but still tentative - but then, he has a broken tooth. Is it coincidence, could he have had pre-existing pancreatitis, or did something with the tooth lead him to develop this? We started syringe feeding low-calorie baby food the evening of his first day refusing food, and moved to a/d the next day. Could his tooth be causing inflammation that triggered this? He ate normally Friday though, so we are assuming he broke his tooth Friday overnight as Saturday was when he ignored food.

-Toby wondered if he really does have pancreatitis…I said the blood test would be fairly definitive - is that right? In the info packet below it seems to suggest WBC are generally elevated. His are a bit low. Same with his liver values. I guess we just find it so strange that he has both at once.

-Why can he not have dental surgery? We are concerned about infection or an abscess developing due to the broken tooth. As well as pain. And if his tooth makes it too painful for him to really eat, how can we distinguish between not eating due to tooth vs. pancreatitis? I was talking to some cat people whose cats had teeth removed during pancreatitis, I’m just wondering if it’s possible for Timothy or if his clinical signs indicate he’s not a candidate. But he got a good check up Monday, it’s just the bloodwork.

Thanks very much! Sorry to be a pain with the one million daily questions!"

 

[jarn]

Vet called back - here's my notes:

-Basically, bloodwork two years when Lear died (Timothy stopped eating with a broken heart) he had highest level of PLI that's normal, so he could’ve had a flare up then from stress
-Pancreatitis in cats is often chronic, and stress can trigger it - I think they're thinking it's chronic with him
-tooth is likely extremely painful (so stress), so could’ve triggered smouldering pancreatitis
-his former overweightness predisposes him - even though he’s lost almost 9lbs since we adopted him 3 years ago
-his PLI is really high at the moment
-unless emergency, not time to put him under as his PLI levels are high
-if giving him time and at home treatment doesn’t help (within the next week), we will likely have to take him to Emergency/Specialist clinic in Toronto for ultrasound with Dr. Mason, to see how severe is it and can he have tooth out (likely have it out down there too) -
-if ultrasound normal, he doesn’t have pancreatitis, have to consider IBD or other issues - but the strong likelihood is it's pancreatitis based on that bloodwork two years ago

 

[daftcat75]

I'd get a second opinion. I don't know that pancreatitis should preclude him from teeth extractions. Also pancreatitis doesn't often show up on ultrasound.

 

[jarn]

I found this:

"It should also be noted that while a pancreatic biopsy in itself is not associated with many complications many patients with pancreatitis are poor anesthetic risks. "

from: VetFolio

I would wonder to if they're worried about the stress of the anaesthesia worsening the pancreatitis as stress seems to be an issue for him.

From what I've read on ultrasound, the accuracy depends on the expertise of the user - I think that's why they'd refer us to the specialist clinic.

I really trust our vet - they've guided us through some very hard stuff, and prolonged life with good quality of life/fixed stuff other vets ballsed up.

 

[daftcat75]

Well, I guess it's bupe and metro until you get those levels down then. I would call that specialist for a consult. Ask your current vet to transfer the records to the specialist. Ask the specialist his/her thoughts on trying to treat the pancreatitis without treating the tooth first. Seems to me that the pain from the broken tooth would probably cause more stress than the procedure to remove it. Opiates and antibiotics are a poor substitute for extractions. But I'm not a vet.

 

[jarn]

We really will have issues affording the specialist and dental extraction by a specialist. Our regular vet quoted $1560-2300 to do the dental surgery with them (before they got the blood results). Dental done at the specialist will be even more. We've spent over $25k on vet bills in the last 6 years, Timothy is not insured (the younger animals are) and our vet fund is down to $550. So if we can get this fixed without going to a specialist, that's preferable. I hate for money to dictate treatment, but our credit is maxed FROM vet bills and we don't have the cash.

The good news is Timothy asked for breakfast this morning (he ignored the wet food), I gave him double amount of kibble and he ate it all! So hopefully that's a good sign from pain from the tooth, and pain from pancreatitis. My husband just gave him some more and he's eating it.

He also came into bed last night and the bathroom this morning.

No diarrhea in the litterbox yesterday too!

 

[neely]

Just out of curiosity, did your vet recommend Prednisolone to help with the pancreatitis? When our guy was diagnosed with an acute pancreatitis attack earlier this year he was put on Prednisolone along with Urgent Care A/D and it helped immensely. He also needed extractions due to FORL but we were advised to wait until the pancreatitis calmed down. We see a feline only specialist and a veterinary dental specialist in the practice. They worked together on Carleton's case and in the end did what was best for him. If you trust your vet go with your gut. Every case is different and no two cats are the same. I sincerely hope Timothy responds to your vet's treatment.

Great news that your boy asked for breakfast this morning and there was no diarrhea. Keep up the good work and keep us posted.

 

[jarn]

Thanks neely. I don't think we discussed prednisolone...I don't remember. He seems to be responding well though which is great. Great relief from us, though he's not out of the woods yet.

 

[jarn]

Timothy is eating food with gusto - we've just been giving him tons of food, we're going to have to go back to measuring food because with his elbow arthritis he shouldn't gain weight. Having trouble giving him his buprenorphine on the gums but he's getting it.

Today as I left the kitchen I saw him eating puke - I thought, great, he's thrown up. Then Cordelia threw up (ate too fast) and Timothy was THERE - I had to swoop in with some paper towel.

(Timothy is as bad as the dogs when Cordelia pukes - he chases after her to get to the puke before the dogs...yeah, there's a reason he weighed 23.4lbs when we adopted him, sheesh)

 

[neely]

I'm so glad to hear he ate with gusto. Hoping it's a sign the pancreatitis is calming down and he can have the dental surgery soon.

 

[jarn]

Same neely - the vet checked in again and are happy with his progress. He's pretty well his usual self, other than the diarrhea.

 

[jarn]

Spoke to vet today. He's doing well - now soft poops, but they're poop shaped. His appetite is great. He's tentatively scheduled for surgery July 30th (geez they're booked up, it was that or the 31st) and he goes in this Friday to recheck his pancreas values. If he gets inappetence again they'll give more pain meds (he finishes them tomorrow). Since he doesn't chew with the canines, they're hoping he will be okay - they don't want to overmedicate, which is why we'll give no pain meds a try first.

But he's eating kibble with gusto, rubbing up against us and other things with both cheeks. It's pretty good. Showing no signs of pain.

 

[Furballsmom]

 

[neely]

Keep the good news coming and keep us posted about his surgery on July 30. Fingers and paws crossed for Timothy.

 

[jarn]

Update! Due to someone at my husband's work testing positive for COVID, he got a test, and our vet (while contactless) didn't want to see Timothy until the COVID results were in. So he didn't get to go for his bloodwork last Friday (dental surgery scheduled for today). We got hubby's test results Sunday - negative (he passed the person in the hall a few times kind of thing, so it would've been shocking if he WEREN'T negative). Tuesday he went in to check his pancreas values - still slightly elevated (3.5 is high normal, he was 3.7, but asymptomatic) and they were comfortable operating given the improvement and lack of symptoms.

His dental went great - all his teeth looked great, he just needed the canine pulled, and it was remarkably in good shape, though the roots were starting to go. We were very concerned about infection/abscesses given the canine broke almost three weeks ago now - but no issues that way.

He's at home now and resting happily!

 

[neely]

Thanks for the update and, best of all, good news for your husband's negative Covid results and Timothy's dental surgery.
I'm sure you're relieved on both fronts.

 

[daftcat75]

Update! Due to someone at my husband's work testing positive for COVID, he got a test, and our vet (while contactless) didn't want to see Timothy until the COVID results were in. So he didn't get to go for his bloodwork last Friday (dental surgery scheduled for today). We got hubby's test results Sunday - negative (he passed the person in the hall a few times kind of thing, so it would've been shocking if he WEREN'T negative). Tuesday he went in to check his pancreas values - still slightly elevated (3.5 is high normal, he was 3.7, but asymptomatic) and they were comfortable operating given the improvement and lack of symptoms.

His dental went great - all his teeth looked great, he just needed the canine pulled, and it was remarkably in good shape, though the roots were starting to go. We were very concerned about infection/abscesses given the canine broke almost three weeks ago now - but no issues that way.

He's at home now and resting happily!

If he was sent home with buprenorphine, use it up regardless of whether he looks like he needs it. Cats are pretty stoic about pain anyway. Better to have a stoned and comfortable cat than a restless and in pain one. And that's great that the pancreas values are almost back in range. He should be feeling so much better in a few days with that tooth out.

Now here's a pro tip that comes from a vet dentist because none of the vets who performed work in Krista's mouth said anything about this. When canines are removed, they can change the way the teeth come together and the way the lips come over the teeth Canines provide structure to a cat's bite. In six months or so, schedule him for another dental and have them look for any signs of lip entrapment or ulcerations in the gums or anything else that might cause him discomfort from having one less canine. Or you could get him on a veterinary dentist's schedule now when he doesn't need it rather than waiting until he does. At least up here in the SF Bay Area, typical lead times for appointments with a vet dentist was two months or longer. Six months with one dentist. It would be better to go with a dentist. Although unlikely, if a problem does turn up, you would need a dentist to fix it anyway. General vets can do extractions but you would need a dentist to fix any structure/bite issues.

Find A Veterinary Specialist | AVDC.org

 

[jarn]

If he was sent home with buprenorphine, use it up regardless of whether he looks like he needs it. Cats are pretty stoic about pain anyway. Better to have a stoned and comfortable cat than a restless and in pain one. And that's great that the pancreas values are almost back in range. He should be feeling so much better in a few days with that tooth out.

Now here's a pro tip that comes from a vet dentist because none of the vets who performed work in Krista's mouth said anything about this. When canines are removed, they can change the way the teeth come together and the way the lips come over the teeth Canines provide structure to a cat's bite. In six months or so, schedule him for another dental and have them look for any signs of lip entrapment or ulcerations in the gums or anything else that might cause him discomfort from having one less canine. Or you could get him on a veterinary dentist's schedule now when he doesn't need it rather than waiting until he does. At least up here in the SF Bay Area, typical lead times for appointments with a vet dentist was two months or longer. Six months with one dentist. It would be better to go with a dentist. Although unlikely, if a problem does turn up, you would need a dentist to fix it anyway. General vets can do extractions but you would need a dentist to fix any structure/bite issues.

Find A Veterinary Specialist | AVDC.org

Yes, he was sent home with bupre, so we plan to use it.

Our vet mentioned that about the removal of a canine and the gums actually. We'll definitely have them keep an eye on it.

I was very happy that he has such a healthy mouth overall.

 

[jarn]

Oh geez. He ate great Thursday night and Friday. Saturday - despite still being on bupre - he refused to eat. We syringe fed him twice, but he was feisty enough more food ended up on the floor. Gave him 50cc of lactated ringers Saturday night. Let vet know what was going on. His incision looks okay to me?

This morning he was clamouring for food - most unlike him - so I called the vet to leave a message (closed Sundays and tomorrow is a holiday) and the vet that was in picked up. She suggested gabapentin. I gave him some mixed in water via syringe (I take it off-label for anxiety, handily enough). I immediately put down food after and he ate almost all of it (so clearly not a med thing), finished it later, and ate more at 1pm. So I think he's okay.

We were really worried about him getting pancreatitis again, and Toby was worried he'd aspirate the syringe-fed food, so refused to syringe feed him this morning before he left for work (as it turns out, it was unnecessary).

We are supposed to be camping with the dogs next Friday-Sunday, and have our much-loved cat sitter coming in, but I'm still not sure I'm comfortable. Timothy was sick most of July, and with his little off relapse - I think we need to be careful of changing routine.