Pancreatitis in a 14 year old cat with IBD - recommendations and prognosis?

lynne8832

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Hi all - I hope you are all doing well!
My 14 year old cat, Shyla, was diagnosed with IBD (possibly small cell lymphoma) a few years ago via ultrasound. We switched her from a regular adult dry food to the Hill's hydrolyzed protein dry food. She was doing very well with just the diet change, with no diarrhea, vomiting, or weight loss for about 2 years.
In June when I came home from school, I noticed that Shyla looked much thinner than normal. She usually weighs about 10-11 lbs., but she was down to about 8.5 lbs. My parents said that while I was away, she was completely normal and had a great appetite with no vomiting or diarrhea at all.
I took her to see an internist in June and they did an ultrasound to see if her IBD had progressed or if there was another issue that was causing her weight loss, despite having no other symptoms.
The ultrasound showed diffuse thickening of the small intestine, but no actual masses or tumors. The internist explained that it could either still be IBD, or it could be small cell lymphoma and that the only way to definitively diagnose her with one or the other was with a biopsy, but that he did not really recommend going that route, since they are treated very similarly.
He started her on a steroid (Budesonide) once daily - the rationale behind trying Budesonide instead of Prednisolone was that Budesonide would theoretically have less side effects, since it targets the GI tract specifically, instead of the entire body.
Shyla has been doing great with the hydrolyzed protein diet and the Budesonide once daily with no issues, and she even gained back some weight.
I am now back at school so I am not home to monitor her, but my parents have said that she has been doing great and continues to have no additional weight loss, vomiting, or diarrhea.
They called me on Friday to let me know that Shyla had no appetite and did not eat on Friday, which is EXTREMELY unlike her. She is usually very food motivated and she never lost her appetite despite all of her GI issues. They brought her to the ER late Friday night where they did bloodwork, abdominal X-rays, and treated her symptomatically with Cerenia and Ondansetron. They did not see any abnormalities on her bloodwork or X-rays, so my parents took her home with medication to see how she responded. They called me on Sunday morning to let me know that she still was not eating and she was salivating and drooling a lot as if she were nauseous.
They took her back to the same ER on Sunday and she was transferred to internal medicine where they did an abdominal ultrasound. They said that her small intestine did not look any more thickened or inflamed than it did back in June (when we did the initial ultrasound for the weight loss) and there were no masses, but she did have pancreatitis/triaditis.
She has been in the ICU since Sunday and they have been treating her with IV fluids and IV medications for her symptoms. They called me this morning to let me know that she ate wet food on her own this morning and she also ate a bit tonight, but her appetite is still decreased, but they did not think that a feeding tube needed to be placed since she is eating. They are planning on sending her home tomorrow, but they are going to call me in the morning with an update. They did say that we should switch her from the Budesonide to Prednisolone, as the Budesonide is likely not strong enough to fully control her IBD.
I have been doing a lot of research on pancreatitis in cats since her diagnosis, and my understanding is that it can either be acute or chronic and it is relatively uncommon for cats to get pancreatitis. It also seems like the prognosis for cats with pancreatitis is extremely variable - with some cats doing great and never having a recurrence, while other cats end up having chronic issues after their first episode.
My questions are - has anyone had a similar experience with a cat that had IBD and/or pancreatitis? Since she is responding to treatment, does this mean that she will likely recover and be okay? Is it normal for her appetite to be returning so gradually and should it continue to improve over the next days/weeks? Should she be on any other medications or should we change her food now that she has had pancreatitis?
I am hoping that she recovers well and can return to her happy, normal, healthy self. I was very shocked that she became so sick so fast because she has been doing exceptionally well with her IBD treatment, so this was very unexpected. I am just concerned that she will not fully recover from this and will continue to have lots of issues now that she has had an episode of pancreatitis.
Thank you all so much for any insight you can provide!
 

daftcat75

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All good questions for the internist. I am not one. Nor am I a vet.

My experience (sample size of 1) with Krista was that she had a couple of flares over a two or three year period. I think pred is a good idea because you really want to get that inflammation under control. While pancreatitis may be relatively uncommon in cats, it's quite common in IBD cats. I forget all the proper scientific reasons. But essentially, there's a congestion point between the liver, pancreas, and small intestines where inflammation in one can spill over into the other two. So getting the intestinal inflammation under control should help prevent future pancreatic (or liver) flare ups.

That she gained weight is a good sign that this is probably not yet intestinal lymphoma. And that's the problem with biopsies. A negative biopsy is only negative today. It doesn't mean that it cannot progress to lymphoma in the future. Keeping the inflammation under control is the best protection against that. Cancer likes to grow where there is uncontrolled inflammation. My recommendation here would be to get a baby scale and make a weekly ritual out of weighing her. For everyone's sanity, only weigh her once a week. If there is a treat she can still have, the way I do it with my Betty is to place a towel in the scale basket (because claws on plastic is an icky feeling for cats), tare the scale with the towel in it, and put a treat at one end of the scale. Re-position your cat as needed while she's eating the treat. She'll learn to get fully in the basket. If and when this progresses to lymphoma, you're going to see it on the scale. It's going to be rapid and relentless weight loss despite an adequate or more than adequate amount of food. And in the meantime, if she's not getting B-12 shots, you should ask the vet about that. Those are simple enough and cheaper to do at home. Ask the vet to teach your parents how to do it and send them home with a bottle of B-12, a Sharps container, and the needles and syringes. She might need weekly B-12 shots at first. But then you can go to once a month. And then whenever she's having a rough time or a weak appetite, you can give an extra shot. She'll just pee out whatever she doesn't need. An extra shot won't hurt her. But it may very well help.

It is not uncommon for pancreatitis to take a few weeks to clear up. During this time, you will likely need supportive medicines for nausea (ondansetron or Cerenia) and appetite stimulation (mirtazapine.) You may also need a pain medicine. Ask your vet if they think this is needed.

It's also my understanding that the treatment regimes for chronic vs acute pancreatitis can be different with acute pancreatitis requiring more in-patient care. Ask the internal medicine doctor who gave you the diagnosis which it is and how to prevent future flare-ups if this is chronic.

Finally, wet food is going to be much easier on an inflamed pancreas (and IBD) than dry food. And the moisture in wet food is going to be better for all of her organs vs. a moisture deficient dry food. Cats are descended from desert cats and will not drink enough water to make up for the missing moisture in dry food.
 

silent meowlook

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Hi. I am sorry your cat has been so sick.

When I worked in internal medicine we saw allot of cats with pancreatitis. Most with favorable outcomes.

One thing to remember is that pancreatitis hurts. Pain medication should always be part of the treatment plan.
 
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lynne8832

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S silent meowlook daftcat75 daftcat75
Thank you both so much for your kind replies!
I am thrilled to report that the specialist called me this morning and let me know that her appetite was increasing and she did great overnight, so we went to pick her up at noon!
She went home with Prednisolone, Cerenia, and Mirtazipine (all in tablet form) and they said to just continue her normal diet, since pancreatitis isn't as closely linked with diet in cats.
I believe her pain was treated while she was in the ICU, but she did not come home with any pain medication (maybe since she seems like her clinical signs have been improving).
She is at home and has eaten a bit, but her appetite is still not back to normal - I assume it will just take a few days/weeks for it to fully return to normal as she recovers?
I also set up a follow-up appointment with her regular internist (the one that she saw in June) in 2-3 weeks so that he can do a recheck ultrasound and we can touch base about her progress.
It's good to know that many cats can do well and return to normal after a flare-up with pancreatitis! Thank you again!
 
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lynne8832

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Hi everyone!
I wanted to give a quick update on Shyla.
She went home on Wednesday (6 days ago) with Cerenia, Mirtazipine, and Prednisone tablets. She has been doing very well overall at home. She seems like herself and her attitude and energy levels are normal. Her appetite returned relatively quickly and she was eating like crazy for the first few days, but her appetite seems to have decreased again tonight. She ate treats this morning as she usually does, but she walked away from her wet food tonight that she usually has for dinner (up until tonight, she has been eating her wet food very well at home). I'm not sure if this is something to be concerned about. She has a follow up with her original internist in 2 weeks, but we will bring her back to the ER that treated her if we need to before then. Can this fluctuation in appetite be considered "normal" during pancreatitis recovery? I'm hoping that this is just part of the ups and downs of recovery and that it is nothing to be worried about, but wanted to see if anybody had advice. Thanks in advance!
 

silent meowlook

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I wouldn’t overly stress one missed meal, but if she does it again, I would be concerned.
Also, if you are able, give Cerenia 1 to2 hours before offering food.
 
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lynne8832

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That's a great idea with the Cerenia! We usually give it around 4 pm and she gets dinner at 6 pm, but we had trouble giving it to her tonight since we usually hide it in a small amount of food (Churu), but she did not seem to have an appetite. I'm hoping this is just par for the course of recovery, since they did tell us when they sent her home that it can take weeks for a full recovery/return to 100% normal!
 

silent meowlook

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While it can take that long to recover, any set back is worth mentioning to the vet.
Another thing to do is to make sure you give the Prednisolone at night. It works better with cats systems that way.
 
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lynne8832

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Hi all!
Thank you so much for your responses.
Shyla ate a little bit last night and a little bit this morning, but she is still walking away from some of her treats and wet food, so I am worried.
She is acting like herself, so that's good!
I left a message for the internal medicine department at the ER and specialty clinic where she was seen and they said that they will call me back before the end of the day, but it doesn't sound like something that she needs to be seen in the ER for at this time.
Can it be normal for their appetite to fluctuate like this during recovery? It's been 10 days since she initially went to the ER and 7 days since she came home, so I guess I was expecting her to have returned back to normal by now, especially since she did so well right after coming home and had a ravenous appetite.
Thanks again!
 
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lynne8832

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Hi all!
I wanted to give an update on Shyla and ask for some advice.
Overall, she is doing okay. She recovered well from the episode of not eating. However, my mom noticed that she was sneezing a lot and was wheezing when she was breathing today, so we took her to her primary vet. They said that her heart and lungs sounded great and she didn't have a fever, so they suspect that she has a URI and not pneumonia. I was concerned that she could possible have aspiration pneumonia from the liquid medications that she has been getting.
Is it possible that she got a URI from being at the ER/ICU for a few days? Or from the stress of being there? She is being treated with a course of oral antibiotics, so hopefully it clears up soon.
She also has a follow-up appointment with her internist this coming Monday (in 6 days), so hopefully he can take a look at her and we can come up with a plan for managing her IBD and pancreatitis long term. She still has days where she doesn't want to eat much and she vomited a few times yesterday - can this be considered "normal" during recovery from pancreatitis? I guess I just expected her to be back to normal by now, so I'm worried about her health long-term. Thank you in advance!
 
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lynne8832

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Is she on anti nausea medication?
She was on Cerenia while in the ICU and they sent her home with about 8 days worth. She is no longer on it - is that something that I should have refilled and continue to giver her every day even if she does not seem nauseous? When she was initially diagnosed with pancreatitis, she was drooling a lot, which is why we suspected that she was nauseous, but she hasn't done that at all since coming home, so I assumed that I didn't need to continue the Cerenia after we ran out, but I could be totally wrong!!
 
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lynne8832

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I have read lots of threads on this site about senior cats that have IBD with concurrent pancreatitis - it seems like the prognosis and outcome are extremely variable. I'm just concerned because Shyla has been having so many ups and downs - one day she will have a great appetite and the next day she won't want to eat at all
 

Jabzilla

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I have read lots of threads on this site about senior cats that have IBD with concurrent pancreatitis - it seems like the prognosis and outcome are extremely variable. I'm just concerned because Shyla has been having so many ups and downs - one day she will have a great appetite and the next day she won't want to eat at all
Hey there,
Have you tried using slippery elm on the days where she doesn’t want to eat? I give some to my cat when he has days where food is suddenly unappealing and it gets him to eat about 30-45min later. Nausea & Inappetence in Cats
 
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