Pancreatitis and expectations

[JackieF]

This is long, sorry! Skip ahead to the final 2 paragraphs if you don’t need all the context.

My sweet, easy-going 14-year-old neutered boy Maude went through a really rough time in January of this year. He stopped eating, was found to have pancreatitis (as well as asymptomatic heartworm disease). The vet said getting him to eat was the most critical part of his recovery, so we planned to have a feeding tube placed so we could give him adequate food, fluids, and meds in a non-stressful way. However, he fooled us by starting to nibble a bit the day before the tube placement was planned, and we got overly optimistic (20-20 hindsight) and canceled the procedure. Sure enough, he then got worse and had to be re-hospitalized. He started having nausea/vomiting, so a feeding tube was no longer an option. He was miserable, and an ultrasound showed worsening of the pancreatitis, so we took him home with only sublingual pain meds for hospice care.

Maude literally went for a full 7 days without eating or drinking even the tiniest amount, just round-the-clock opioids. And then one evening he perked up his ears when I said “treaties.” So I got the package, and he ate 7 cat treats! Then he drank water, LOTS of water. And over the next few weeks he ate more, and got strong again. The vet actually cried when he saw Maude next. After starting on Mirataz to further nudge his appetite, Maude regained all the weight he had lost. He continues to drink a lot, so I worried about his kidneys, but another ultrasound, urinalysis, and routine bloodwork looked fine. There was never any cause determined, nor were other organs involved.

But of course there’s a problem, or I wouldn’t be posting. Maude has lost his appetite again, despite continuing on the mirtazapine. He still eats a little, mostly only treats now, sometimes the gravy from canned food also. His energy has dropped, just a bit. He’s drinking fine, no vomiting or apparent pain. No change in the litter box. He’s not hiding or acting different. He still seems to enjoy the things he always has, aside from eating. I believe he has developed chronic pancreatitis and is having a flare-up. Obviously, h will go back to the vet if he doesn’t improve soon.

I’d like to hear from others who have dealt with this. How long will a flare last? Should I consider a feeding tube again? I’m trying not to be selfish — I don’t want Maude to suffer!- but he still seems to have a good quality of life right now, and if simply getting proper food into him could maintain that... I want to think about these things before I go back to the vet. Thanks for listening, and for any insights you can share.

 

[She's a witch]

My understanding is that pancreatitis always have an underlying cause. And yet, most of the cases are considered idiopathic. So I’d focus on finding the cause if at all possible to see if that could be managed. Were his Intestines good on the ultrasound? No IBD? I’ve known a cat that had pancreatitis attack until they found the piece of plastic stuck in his GI track (not visible on ultrasound nor xrays, only X-ray with contrast shown a possibility of something stuck, which only exploratory surgery confirmed).
Does he receive any pain killer? Pancreatitis is very painful and it’s possible he’ll eat better with some strong pain medication. The more he eats, the sooner his pancreas heals.
All the best to you and your kitty!

 

[She's a witch]

Also, he needs fluids. You can ask your vet to teach you how to administer them at home to avoid hospital visits

 

[JackieF]

My understanding is that pancreatitis always have an underlying cause. And yet, most of the cases are considered idiopathic. So I’d focus on finding the cause if at all possible to see if that could be managed. Were his Intestines good on the ultrasound? No IBD? I’ve known a cat that had pancreatitis attack until they found the piece of plastic stuck in his GI track (not visible on ultrasound nor xrays, only X-ray with contrast shown a possibility of something stuck, which only exploratory surgery confirmed).
Does he receive any pain killer? Pancreatitis is very painful and it’s possible he’ll eat better with some strong pain medication. The more he eats, the sooner his pancreas heals.
All the best to you and your kitty!

Thanks for this! Our vet didn’t really devote much effort to finding a cause for the initial bout of pancreatitis, just did as you noted and considered it idiopathic . The ultrasonography is supposed to be pretty skilled, however, and on all 3 exams nothing unusual showed up in the surrounding organs and tissues. They didn’t do any Xrays.

I should’ve mentioned that I have tried giving Maude some of the Cerenia and buprenorphine left over from January’s adventure, just in case pain or nausea were an issue, but they didn’t make much difference. He normally weighs about 13-14 pounds. For the past few days he’s been drink about 300-350 ml water per day, and getting about 250 kcal, mostly from crunchy cat treats. (Normally he eats mostly pate-style canned food.) No vomiting or loose stools.

 

[She's a witch]

It might be totally different thing, I’d be worried about kidneys too; I’d take him for tests if I were you.
Fingers crossed it’s nothing serious!

 

[BlackCatOp]

Sorry you have had to deal with pancreatitis in your kitty. It is a terrible disease and I believe acute pancreatitis is under diagnosed in the feline population (my own senior kitty suffered from the disease last year.)

The cause of acute pancreatitis in cats is unknown. For dogs the link has been associated with high fat foods, garbage eating (typically around the holidays) but there has not been the same association made in cats. Since cats are naturally designed to digest higher fat meals than their canine companions, I suspect that is why fat does not play a role in feline pancreatitis. Also, acute pancreatitis is sterile - there is no actual infection of the pancreaes but autodigestion that causes profound inflammation.

Chronic episodes after the initial event are common. Sometimes they go undetected and other times the attacks are more severe.

I agree that you need to take him to the vet. Especially, since the meds provided no relief - something else could be going on or he needs additional intervention. Whether to proceed with treatment is a difficult discussion and hopefully your vet can provide some guidance. In hindsight, my family regrets putting Sassy though what we did but at the time we didn’t know what we where getting ourselves into. (Plus it’s hard to end treatment once $3k had been spent.) Is he healthy and happy otherwise? You could also see his initial response to treatment before making a final decision. As far as eating, Sassy loves Fancy Feast Broths. While not complete and balanced or composed of the greatest of ingredients, it was the only thing she would eat by mouth during her recovery.

Here are some articles you may find useful
https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2016/06/T1501F01.pdf

Diagnosis and treatment of feline pancreatitis

Best luck and I wish him a speedy recovery!

 

[JackieF]

Thank you, BCO, for those articles - they were indeed very helpful. Of course you and SAW are correct — Maude does need to see his vet, and it certainly could be a different problem entirely. We have an appointment tomorrow morning. (I’ve been a nurse for 20 years, so I can’t help trying to diagnose every health issue I come across, but my track record is better with humans.)

 

[JackieF]

Maude saw the vet yesterday for an exam and labs. His SNAP fPL came back abnormal again, so they said it was pancreatitis. The only other time he’s had that test was at the start of his major illness in late January, so I don’t know whether it’s has stayed abnormally high all along.

His creatinine was 5.0 and BUN was 55, so he’s also in renal failure. I suspected this 3 months ago because he was drinking a lot, but in March his creatinine was only 2.5 and BUN was 34. They used ultrasound-guided cystoscope to get a urine sample in March (no proteinuria, specific gravity 1.03), and looked briefly at his kidneys then and thought they looked okay. So this is a big change in three months! His phosphorus has increased from 4.6 to 7.2. Electrolytes, liver enzymes, and CBC are all good.

They gave him a Vitamin B-12 shot and a subQ fluid bolus, then strongly encouraged me to take him home and just keep him comfortable. Which I guess is what I will do. Right now he still eats a fair bit, mostly crunchy cat treats fed by hand, but also a few spoonfuls of his regular canned food when the mood strikes him. He hasn’t really lost any weight yet. He drinks a ton! I’ve put extra water bowls around the house, and he uses them. He snoozes a fair bit, but still follows me around and love-bombs me several times a day. He doesn’t hide, doesn’t vomit, doesn’t show any signs of pain.

I’m not sure whether I’ll be calling the mobile pet euthanasia vet in days, weeks, or months. I guess I should still give him his Revolution Plus when it come due this week, right? He still likes to go outside and sit on the patio.

 

[JackieF]

Just an update — Maude does not pay attention when his vet says he is very sick and likely to die soon. Maude does wish, however, that I would take the hint and stop taking him to the vet.

He has resumed eating his canned cat food at the usual rate, although he is not interested in most of the lower-phosphorus varieties I have attempted to introduce. The vet is really not encouraging about further treatment, given that Maude nearly died from necrotizing pancreatitis a few months ago, is heart worm-positive, and just recently had another pancreatitis flare and was diagnosed with renal failure. I get it. It’s also currently really difficult to take Maude in to the vet, as we live in a large Texas city that is surging with COVID-19.

I have added a phosphate binder to Maude’s food, and I’m adding extra water to it. I continue to give him the Mirataz for appetite stimulation. And he is acting like a fairly healthy elderly cat. For now, this seems good enough.