pancreatitis and not eating...

[Psalcal]

So my 16 year old cat Pixie has been diagnosed with Pancreatitis... she previously has been diagnosed with either IBD or cancer, we decided against the biopsy to determine which due to similar treatment options. She has been on chemo and steroids for 2 years for treatment.

She had stopped eating a week or so ago and we had a ultrasound done today. Cancer and IBD looked like it hadn't significantly progressed. But she has pancreatitis now.

There is a LOT of info out there. Here are a few really good links from other threads:

Diagnosis and treatment of feline pancreatitis

https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2016/06/T1501F01.pdf

Pancreatitis care advice needed

Appetite stimulants have not worked (Miritaz) anti nausea (Ondansetron and Cerenia) have not seemed to help. Pepicid as well. We stopped those things today but we're really confused about why they weren't helping. Vet seems to indicate the Pancreatitis explains the lack of eating. The vet unfortunately didn't have that much time to talk through things more deeply.

Pixie has responded well to syringe feeding, so at least that.

It seems like the prognosis for Pancreatitis is not so good... and further, it seems like it's really hard to get specific info on where to go from here. The idea of a feeding tube is on the table, but besides the expense, it seems like it might either be futile or would prolong things quite a bit, but at what cost to ongoing health issues and suffering? If she has pancreatitis and we feed her through the tube, how can we know if she has good quality of life with pancreatitis?

I know some of these questions might not be answerable, but appreciate the thoughts. anyway. We're trying to get a consult with our local vet instead of the specialist as well.

 

[Mamanyt1953]

This one pushes a LOT of buttons for me. I very nearly lost Hekitty to pancreatitis. My vet was very honest with me, and told me that it would almost certainly become chronic, and her quality of life would be very poor, so I steeled myself to saying goodbye. To the surprise of both the vet and myself, she recovered in about a week, has never had another attack, and my main problem is trying to get weight OFF of her! So I guess my advice is to take this daily. Give her some recovery time, then revisit your options. While you NEVER want to give up on a cat too soon, neither do you want to wait too long.

I'm lighting a candle for you and Pixie. My heart with yours.

 

[Psalcal]

To the surprise of both the vet and myself, she recovered in about a week, has never had another attack, and my main problem is trying to get weight OFF of her!

Wow, thank you. Can you give me info on what you did differently, or what happened that week? No feeding tube? Appetite stimulants just started working? Thank you for the response.

Can has not eaten well in 1.5 weeks already, and has not eaten without syringe in a few days too.

 

[Psalcal]

Oh and thank you for the candle and thoughts! Ain't easy, as you know...

 

[Mamanyt1953]

I syringe fed for a couple of days, then the appetite stimulants started to work. I think that the inflammation and nausea began to subside enough at that point that her desire to eat was stronger than the upset it caused, but I'll never know for sure. She was right on the edge of hepatic lipidosis, as well, and that cleared up...although I now have a "NO MORE THAN 48 HOURS WITHOU EATING" rule, and that's hard and fast. I can't risk her, knowing her liver was compromised, even though her senior panel was completely normal.

 

[She's a witch]

Is she getting any IV fluids and strong pain medication? Pancreatitis is very painful and if she’s in pain, no wonder she doesn’t want to eat. All the best for you and your kitty!

 

[Psalcal]

No IV fluids... I'm a little confused as to why they didn't do so.. she had sub-Q fluids yesterday though. We have a request in to our local vet for a consultation on next steps. I feel like we're just stuck right now... a little scared for her. She's more subdued than normal tonight but not hiding. Still wants to be out with us.

 

[Psalcal]

OK related.. does anyone know where I might go to get a consultation with another vet, maybe an on-line one? With an internal medicine specialist? My local person who did the ultrasound has not been very reachable or all that helpful with specifics. Anyone have any resources/ideas?

 

[Psalcal]

So here's the rundown for care moving forward...

1. Continue syringe feeding since she is very tolerant
2. Continue Cerenia and steroids, discontinue appetite stimulant for now (not working). Vet says Cerenia is also effective for some of her discomfort.
3. Hope that her pancreatitis just sort of calms down. Could happen, might not happen. At some point we will need to make a choice if she doesn't get better.

Last night she was uncomfortable, hard to say how much, but she seems more comfortable today though still not herself. It's a bit heartbreaking, but at least there is still some hope.

 

[neely]

does anyone know where I might go to get a consultation with another vet, maybe an on-line one? With an internal medicine specialist? My local person who did the ultrasound has not been very reachable or all that helpful with specifics. Anyone have any resources/ideas?

You can locate a medical specialist at a University Veterinary Medical School, e.g. Cornell, U Penn, etc. There are also veterinary specialty centers affiliated with medical schools in different states. Here is a list of veterinary medical schools:
Members
And you can locate a feline practitioner here: AAFP | American Association of Feline Practitioners

I'm so sorry your cat is going through this and sincerely hope you can find the help you need.

 

[daftcat75]

Krista had pancreatitis a couple of years ago. The prognosis depends on whether it's chronic or acute. Acute means something very specific brought it on very suddenly--usually an environmental or ingested toxin. Acute pancreatitis usually requires inpatient care with IV fluids and aggressive support. But if they make it through that acute flare-up, then there's no reason to expect a recurrence (as long as the offending factor is not reintroduced. Chronic just means some process already happening within her spilled over into the pancreas. It doesn't necessarily mean that she will have recurrences. In Pixie's case, it is probably her IBD/lymphoma that is causing some spillover inflammation in her pancreas. The liver and pancreas share a common duct into the intestines in cats. So it's common to also have some kind of liver inflammation concurrent with pancreatitis. Did your vet test for this or mention any abnormal liver results?

The good news is that the prognosis for both pancreatitis and non-hepatic lipidosis liver inflammation is rather good. The treatment is also the same. Control the inflammation, the nausea, and the pain, and feed her way through this. Gut rest is not recommended for cats with pancreatitis because of the risk for hepatic lipidosis. But even if she already has some hepatic lipidosis going on, the treatment is still the same. Feed her back to health.

As procedures go, a feeding tube is not a very expensive one. The procedure itself will be in the neighborhood of $150. It's the anesthesia and supporting injections (anti-nausea and pain) plus a confirmatory X-ray to make sure the tube is placed correctly that will run the total bill up to perhaps $500. You paid more for the ultrasound, I'm sure. The benefit of the feeding tube is that you take the responsibility off the cat and you get an active hand in her recovery. Now if she starts feeling well enough to eat on her own, well, then, that's less food you have to put down the tube. Once she's eating enough food on her own, you can have the tube removed. She'll heal up in a week like it was never there. The neck fur will take a bit longer to grow back.

 

[Purr-fect]

One of our cats recently went thru this. He was diagnosed with pancreatitis. His symptoms and blood work supported the diagnosis. Dont give up researching, learning and syringe feeding him.

I immediately jumped on the Internet and started irritating our vet with questions based on my half learnt information. But she was patient and it was helpful to me as I got a better understanding of what was happening.

Fortunately our cat was tolerant to the syringe feeding. Within a week he was back to nibbling on his wet food and soon after was back to his old self.

I kept reading the vets "treat the symptoms" of pancreatitis: nausea, loss of appetite, pain and lethargy. They dont cure the illness. Seems they figure if the symptoms are gone, so is the pancretitis. I wont repeat what you have already learnt.

Just want to give you hope. Our guy bounced back quickly. He only lost about a pound....dropped from 20/21 to 19 pounds. I weighed him the other day and he is now 22lbs.....which is a healthy weight for him.

I would consider another vet. It seems yours is not very helpful. Our vet did help us understand what was happening, gave us guidance and explained and recomended options. That plus the internet information, gave me some confidence to move forward.

We still watch carefully at every feeding to see if symptoms have returned. So far so good, its been about 8 weeks now, symptom free.

 

[Psalcal]

$500 for a feeding tube?? That would be amazing. Our vet has quoted $2500. We're in California. daftcat75, not sure where you are located... I suppose I can call around, but I'm not sure how many options there are around here. But thank you for that. The ultrasound was about $750 I think. Everything here is expensive. We have no insurance either so that doesn't help!

I appreciate the additional information you provided. My vet did not talk about the difference between acute and chronic. I assume, since nobody recommended the IV treatment, and there was no mention of liver results. I will ask that. Thank you!

We are finding it takes my wife and I about 20 minutes end to end to feed her each meal with syringe feeding. She is taking it well. We're not opposed to the feeding tube, though I don't like the thought of putting her through it.. she's already very lethargic and more surgery doesn't seem like a good idea.

BTW she IS super lethargic... she's not the most active cat at 16 of course, but she has maybe 10% of the energy as normal. Vet seems to think this is OK.

 

[Psalcal]

I would consider another vet. It seems yours is not very helpful. Our vet did help us understand what was happening, gave us guidance and explained and recomended options. That plus the internet information, gave me some confidence to move forward.

We still watch carefully at every feeding to see if symptoms have returned. So far so good, its been about 8 weeks now, symptom free.

Your post was VERY helpful. To be honest I was giving up hope a little, and you both have provided some real world input which is VERY helpful.

Right now it will be about two weeks tomorrow since this began. I don't know how long is reasonable to wait for something to change/get better... nothing I read online has helped me understand this. Both of your cases, it sounds like your cats recovered much more quickly than Pixie. I'm going to do more research on how long it should last and see if I can dig anything up. I really don't want to make her suffer, just very hard.

 

[daftcat75]

$500 for a feeding tube?? That would be amazing. Our vet has quoted $2500. We're in California. daftcat75, not sure where you are located... I suppose I can call around, but I'm not sure how many options there are around here. But thank you for that. The ultrasound was about $750 I think. Everything here is expensive. We have no insurance either so that doesn't help!

I appreciate the additional information you provided. My vet did not talk about the difference between acute and chronic. I assume, since nobody recommended the IV treatment, and there was no mention of liver results. I will ask that. Thank you!

We are finding it takes my wife and I about 20 minutes end to end to feed her each meal with syringe feeding. She is taking it well. We're not opposed to the feeding tube, though I don't like the thought of putting her through it.. she's already very lethargic and more surgery doesn't seem like a good idea.

BTW she IS super lethargic... she's not the most active cat at 16 of course, but she has maybe 10% of the energy as normal. Vet seems to think this is OK.

I'm in Santa Clara county in California. Probably only San Francisco is more expensive.

This was the estimate if Krista needed a feeding tube after the ventral bulla osteotomy she just had.

Esophagostomy Tube Placement 0 → 1 $0.00 → $248.85 Induction - injectable 0 → 1.5 $0.00 → $106.50 Anesthesia Each 1/2 hr 0 → 1 $0.00 → $270.00 Radiograph - View Tube Placement 0 → 1 $0.00 → $81.11

Those add up to about $700. This was from a specialty hospital. A regular vet's office may not charge so much and for every little thing. The estimate also included whether they needed to do feedings and shifts of feedings. When Krista had her tube done last year, the feedings were not on the bill. Luckily, Krista is a rock star and resumed eating as soon as the anesthesia wore off this past Tuesday so no tube was needed this time.

$2500 is way too much. Ask the vet to itemize the estimate and then take it to someone else if it still looks too high.

 

[daftcat75]

Your post was VERY helpful. To be honest I was giving up hope a little, and you both have provided some real world input which is VERY helpful.

Right now it will be about two weeks tomorrow since this began. I don't know how long is reasonable to wait for something to change/get better... nothing I read online has helped me understand this. Both of your cases, it sounds like your cats recovered much more quickly than Pixie. I'm going to do more research on how long it should last and see if I can dig anything up. I really don't want to make her suffer, just very hard.

I got Krista through pancreatitis with a lot of high value food (mostly Tiki Cat tuna based foods), nutritional gel (high calorie gel), fish flake treats, and a whole lot of begging. I also used some supplements from Vitality Science. I almost don't recommend this approach because I believe she would have come around faster with traditional medicine. I also think our discovery of Rad Cat (a commercial raw food that doesn't exist anymore) was probably an important part of her recovery. It took about two months of meticulous, frequent feedings--weighing everything, keeping track of grams served and calories per gram to get her total daily calories up. Many times she would only eat about 20 calories in a serving. About a tablespoon of food. So I'd make sure she ate 10 times that day.

 

[Psalcal]

Maybe if you don't mind would you share or PM your vet info? We're in Redwood City so really right down the road. The specialty vet is in San Leandro. Sounds like your vet is way better... and less expensive.

Pix won't eat by herself at all.. nothing, period. We can't leave her food out at all as we have another cat (little glutton he is). But we keep trying.

When you say "nutritional gel" do you mean this:
Cat-Cal™ Nutritional Gel - NaturVet

Never heard of that... that is super high calorie, that looks like a good idea to add to her diet. Right now it's just pure turkey baby food. Trying to get 4 jars a day in.

I can get her to take a teaspoon of the nutritional gel a day, which appears to be the recommendation.

 

[daftcat75]

Maybe if you don't mind would you share or PM your vet info? We're in Redwood City so really right down the road. The specialty vet is in San Leandro. Sounds like your vet is way better... and less expensive.

Pix won't eat by herself at all.. nothing, period. We can't leave her food out at all as we have another cat (little glutton he is). But we keep trying.

When you say "nutritional gel" do you mean this:
Cat-Cal™ Nutritional Gel - NaturVet

Never heard of that... that is super high calorie, that looks like a good idea to add to her diet. Right now it's just pure turkey baby food. Trying to get 4 jars a day in.

I can get her to take a teaspoon of the nutritional gel a day, which appears to be the recommendation.

That estimate was from SAGE. They have a Redwood City location. I would also look at VCA as another option.

Home | Redwood City

She needs real cat food, nutritionally balanced. You can use baby food in a pinch for a short period of time. But at this point, it's been too long and you run the risk of nutritional deficiencies. Go to the pet food store and pick up some Tiki Cat tuna flavors, some of the Tiki Cat Velvet Mousse pouches, Fancy Feast Classic Pates, even Friskies--whatever you think she might eat. It's better to feed what you might think is garbage (as long as it doesn't flare up her IBD) that's nutritionally complete than an incomplete meat-only baby food. Better to dine at McDonald's than starve at Whole Foods.

 

[Psalcal]

Ok we are definitely considering switching to sage. Thanks for that. VCA/BAVS is her normal Cancer and IBD vet.

Our vet suggested baby food to get her back to eating then something like I/D.

Could be wishful thinking but maybe she’s a little better today. Time for yet another feeding.

 

[daftcat75]

Ok we are definitely considering switching to sage. Thanks for that. VCA/BAVS is her normal Cancer and IBD vet.

Our vet suggested baby food to get her back to eating then something like I/D.

Could be wishful thinking but maybe she’s a little better today. Time for yet another feeding.

Baby food can be used in a pinch to restart eating. But more than a week or two and you run the risk of nutritional deficiencies. The biggest risk off the top of my head is a calcium deficiency. Calcium is used by the body for muscle contractions, nerve conduction, and pH regulation. If there isn’t adequate calcium intake from food (and there isn’t with baby food), the body has to rob the bones of calcium to keep those things working. But calcium has to be balanced with phosphorus, of which a meat-only diet is high in, in order to avoid kidney problems. Rather than thinking nutritional gel or a supplement can fix this, it’s just easier to find whatever food your cat will eat and feed her that (as long as it agrees with her IBD.).

One huge benefit of a feeding tube is that you don’t have to consult your cat’s picky tastes to get nutrition in her. If she doesn’t like I/D, tough. As long as it agrees with her, you can bypass her “I don’t want that.”

Heres the most important thing about pancreatitis that I wish I mentioned earlier. The inflammation that causes it also causes the digestive enzymes to backup into the pancreas. The reason why pancreatitis is painful is because the pancreas is literally digesting itself. The longer it goes untreated, the more it can permanently damage the pancreas. You can end up with a diabetic cat if the pancreas is damaged enough.

In other words, it’s make or break time. Get her inflammation under control and get her eating real cat food again. If that’s not by mouth, then do it by tube.