Pancreatitis Questions

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merlotandasti

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First, I will start off with some background information about my little buddy, Asti. He is almost 14 years old. 4 years ago, he began having urinary issues that resulted in stones. He had his first cystotomy in 2018. He did very well up until last year other than some constipation issues & strange digestive "flare ups" that would go away on their own relatively quickly. In August last year, I took him in because he was seemingly constipated & would hunch over in pain. They found he was mildy constipated & had bladder stones again along with kidney stones. Another cystotomy was preformed, but this time, when he returned home, he seemed very sick. I pressed them to do blood work & his kidney levels were off the chart. He was hospitalized for a week, on constant IV fluids & a kidney diet. He really struggled to make it through it but his levels returned to normal. Ever since then, Asti has been on sub q fluids (at that point, twice a week) & epakatin. He stayed on his Hills prescription wet CD diet to prevent stones. A few months later, he was very impacted. Straining to defecate & having his weird digestive flare ups. He got an enema & was sent home. In November 2020, he began to slowly lose weight. He has been to the vet about a million times, always checking his blood & urine. No signs of infection for his bladder. Xrays show no stones other than his kidneys. They would treat him with an antibiotic shot & he would do well for about 2 weeks then begin to hunch over in pain & "slow down" activity wise again. I was searching for answers desperately because I hate to see my baby in pain. His blood work always showed slight elevation in white blood cells, mild anemia, & slightly elevated kidney values (but not bad for a cat that is CKD). Fast forward to April this year. He has lost almost 2 lbs in 5 months, his appetite dropped to almost nothing, & he keeps straining in the litter box. Finally his new vet suggested an ultrasound. We did the ultrasound & the bladder looked fine. Kidneys had stones towards the bad & mild damage to the kidneys. But they happened to find that he had inflammation in his pancreas. We started him on metronidazole/ursodil (100/50mg), prednisalone, buprenorphine (only until he stopped hunching over in pain), & his sub q fluids every day. It worked wonders. He gained some weight back, appetite was normal. No vomiting. & he was playing like a kitten again & enjoying life. This lasted a solid month or so. A few weeks ago, my buddy started having some blood on his stool & straining even though his stool was soft. & he began to defecate outside of the litterbox occasionally. He started slowing down. Appetite started to go away again.. he couldn't get comfortable or sleep well. I began to think he's having another pancreatitis flare up.. even though he only did well for a month. I took him to his vet last week to get some answers. We did more blood tests & xrays. Blood tests showed some slightly elevated kidney lvls (but HIS normal), one liver level was a little off, slightly worse anemia but the Dr said he wasn't too concerned bc of his previous blood results, & we also found that he has FIV. His xrays didn't show anything too abnormal. He saw the kidney stones & quiet a bit of gas in Asti's digestive tract. Also found out that he has a pretty uncomfortable back.. I also want to mention on a positive note that he actually gained an ounce or two, so no weight loss. We are at a loss.. I'm not sure why the metronidazole/ursidol/pred isn't working anymore. The Dr said he is probably struggling so much more to fight it off bc he is FIV. We are currently giving the fluids, metronidazole, pred, mirtazapine for his appetite, cerenia for nausea, buprenorphine & gabepenton for pain, & fortaflora to help with the diarrhea. He hasn't been doing well. I don't know how long it should take for him to get better.. & I'm so worried I will lose my buddy or that he will suffer too much. I can't even fathom losing him.

I began feeding him instinct duck wet food & sometimes instinct limited ingredient wet food. I read that it could help cool down his digestive system (not sure if that is accurate or not). He takes all his meds everyday. His diarrhea has slowly become more solid. I occasionally see some dark red blood in it but not often anymore. He sometimes defecates outside the litterbox right now. I take it as he is uncomfortable right now. After 2 doses of the mirtazapine, he has began to eat almost a normal amount again. He's also drinking a ton of water. Even though he gets 100ml of fluids a day. But I'm really happy he's drinking a lot to rehydrate himself. The biggest issue is his pain. He will walk around slowly & hunch over. I don't want him to hurt. & I'm scared that his meds aren't healing his pancreatitis. I don't know how long it should take to heal this flare up.. I don't want to lose hope since he has began to eat & drink again. & he's engaging in more normal behavior like sleeping near me & jumping on the counter for some water. He is also beginning to sleep better.

I would love to hear others' experiences & thoughts. Idk if he has IBD along with the pancreatitis or if this sounds like something else entirely. His vet doesn't seem to think cancer is involved bc of his ability to gain some weight back in a month & keep it even when this flare up has began. I also want to mention he has a heart murmur that he was diagnosed with 3 months ago. We had his heart checked by an ultrasound tech & it is clear & good. Also he rarely vomits & when he does, there isn't any blood or strange in it.

Has anyone used any other type of treatments for these things? Or experienced anything similar?

Advice is also very welcome. I would like to mention anything to my vet to try to help Asti. He is truly a fighter. & despite the past few months, I can tell he doesn't want to give up even though he is worn out from everything he has gone through.

Thanks in advance from Asti & I!!! We will keep fighting no matter what! ❤
 

silent meowlook

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You have allot going on there.
Ask your Veterinarian about Vitamin B 12 injections. You can give it with the SQ fluids.Ask about adding Visbiome ( probiotic) to food. Ask about feeding a novel protein diet such as Venison or Rabbit and only feed it, no treats etc. Feed canned food only.
FIV is not a death sentence but it will make him more susceptible to other health problems. Keep an eye on his teethe as often FIV cats have dental issues.
Get a low side litter pan, or cut your down on one side so it is more accessible. If you only have one box, add another. If it is covered, take the cover off.
Try to wean the Prednisolone down, with your Veterinarians okay. Never stop giving it abruptly. Metronidazole can be hard on the gut. Only give on a full stomachs or with food. Try giving the Cerenia an hour before the Metronidazole. For break through nausea, ask your Veterinarian about Odansetron. It has to be given SQ but you could do it in the SQ fluid line.
The pancreas is hard to visualizeon ultrasound, but there are simple blood teststo determine if your cat has it. The test is called an FPLI. Another test you should consider is a Pro BNP. It checks for heart disease. If you are doing fluids, use caution as to much can cause congestive heart failure, especially in a cat with heart disease.
Pancreatitis is painful. I would imagine the kidney stones are painful as well. What is being done to address the stones?
If it was me, I would consult with a boarded Internal Medicine Veterinarian ASAP.
 
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merlotandasti

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You have allot going on there.
Ask your Veterinarian about Vitamin B 12 injections. You can give it with the SQ fluids.Ask about adding Visbiome ( probiotic) to food. Ask about feeding a novel protein diet such as Venison or Rabbit and only feed it, no treats etc. Feed canned food only.
FIV is not a death sentence but it will make him more susceptible to other health problems. Keep an eye on his teethe as often FIV cats have dental issues.
Get a low side litter pan, or cut your down on one side so it is more accessible. If you only have one box, add another. If it is covered, take the cover off.
Try to wean the Prednisolone down, with your Veterinarians okay. Never stop giving it abruptly. Metronidazole can be hard on the gut. Only give on a full stomachs or with food. Try giving the Cerenia an hour before the Metronidazole. For break through nausea, ask your Veterinarian about Odansetron. It has to be given SQ but you could do it in the SQ fluid line.
The pancreas is hard to visualizeon ultrasound, but there are simple blood teststo determine if your cat has it. The test is called an FPLI. Another test you should consider is a Pro BNP. It checks for heart disease. If you are doing fluids, use caution as to much can cause congestive heart failure, especially in a cat with heart disease.
Pancreatitis is painful. I would imagine the kidney stones are painful as well. What is being done to address the stones?
If it was me, I would consult with a boarded Internal Medicine Veterinarian ASAP.

Thank you for the response & advice. I will ask about the B12 shots & the probiotic. He actually has 2 litterboxes at the moment, his litter robot & just a normal low one. I left the lid off the second one. He's never peed outside of the box, only poop.

As far as the heart health goes, they brought in a a specialized tech to do the ultrasound & look at everything & cleared his heart that way. Would I still need to do the blood tests? & also as far as diagnosing the pancreatitis, was the ultrasound not good enough? He responded to treatment for pancreatitis the first time around. Are their other illnesses that respond to the same treatment?

Ever since his hospitalization in August, he has been a terror at the vets.. most of the time they can't even draw blood without sedation & I really don't like them to put him under so many times. That's why I ask if the blood tests are necessary or if the ultrasounds were good enough.

As far as the kidney stones go, I read (& the vet also agreed) that not much can be done about those other than trying to keep the size of them small or having surgery to remove them. But the surgery is risky & damages the kidneys. Are there other things we could be doing? He has calcium oxalate stones so they can't be dissolved, sadly..

He goes to a cat only specialized vet clinic. How would I find out if they are have boarded Internal Medicine Veterinarians?

Thank you again for all the valuable information. I really appreciate it!!
 

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Hi. Glad you go to a cat only Veterinarian. If it was my cat I would skip any additional testing since he gets so stressed. Have they ever suggested that you give him Gabapentin before visits to make it less stressful for him?

It sounds like really you are doing the best you can with him.
 
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merlotandasti

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Yes we do give it before. But for some reason, it doesn't seem to be strong enough. Maybe it's because the vet only advised to give half a capsule as to not harm his kidneys too much more.

I do want to say that I have seen some gradual progress. He doesn't seem to be crouching down as much today & his poop has become solid again so far. Also he is becoming more alert & has been eating & begging for food like he used to without the mirtazapine today. I'm hoping that we will continue to go up from here. I will definitely ask the vet about the things you suggested though. His vet asks us to give him updates regularly so we stay on top of things!
 

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Yes, you do have a lot going on in an older cat. Pancreatitis can be hard to treat; my old GSD narrowly recovered from that about a year ago and it was so stressful that the vet actually allows me to keep the meds on hand in case I even suspect that another is starting.

You have tried a lot of interventions and see a cat only vet as I understand it. I don't know where you live, but if you could get to a specialist, a referral clinic, a teaching hospital, or ask your vet to speak to a specialist it might payoff. Your vet sounds very good; this is not a criticism of him but as in human medicine, a specialist is a specialist. You may also find that in the long run it saves you money and saves your cat extra trips to the vet. I would at least try for a veterinary internist. There are other specialities in the veterinary world, but you might have trouble locating some of them.

I do want to second the pancreatic lipase test and also mention that my dog has trouble with metronidazole being hard for him to assimilate and his vet gave me a very specific schedule of when to administer all his meds, what to give with food, and how to space them out.
 
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merlotandasti

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His vet said if the treatment doesn't work this time, he would refer me to a specialist in the area. I'm a bit worried about the price considering that I've spent at least 8k on him since August between surgery, hospitalization, visits, & meds. But maybe I could give them a call to see what the prices would look like & what they might suggest. I can't let my buddy sit in pain, so I will do everything I can.

Today I started giving his meds after he ate to see if that will help. I really appreciate all the advice. I would have never known to do that.
 

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Usually with these places there is a consultation fee...which is more or less for walking in the door and talking to the vet about the cat's condition. It runs, around here, about $150. At that time, the specialist will offer more testing, no doubt, which will add up. However, as I said, if you can get to the root of this it will save you money in the long run. When you go, have a list of questions, in writing if necessary or whatever form works for you, and ask what each recommended procedure or test will help to determine, don't be shy about mentioning that you are not made of money and have to make the most careful decisions so that you get the most for your visit.

Your baby is so adorable sleeping on his blanket.
 
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merlotandasti

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Thanks for the heads up. I think it would be at least worth a try if things don't get better for him soon. I went through at least 5 vets until I got to the place I am now. I felt like other places would just write him of thinking nothing was wrong even though I could tell he was sick & hurting. I wasted so much money at those places & I know it was a waste of stress for Asti. If only I knew then what I know now. But we can't go back in time so we will continue to move forward with the knowledge we have now!

& thank you! He is very cute & spoiled 🤣
 

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Remember that all paperwork and test results from previous vets are your property and you have to be given copies. If you see a specialist, try to get all this together to show him. It might also prevent the same test from being run if it is not necessary or the last one was timely enough.
 
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merlotandasti

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I wanted to ask another question that someone might have some answers for.

Is there anything I can do to help with Asti's anemia? It is mild, but I read that heart murmurs can be caused by anemia. They said it was between grade 3 & 4. & he only recently was diagnosed with it a few months ago after being mildly anemic for several months.

Even though he has been cleared of any heart disease, I don't want this to progress into anything. I worry about the fluids because of that. But the vet said I shouldn't worry & that his kidneys will thank me for it.
 
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merlotandasti

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Yes I do. Also I just noticed the vet did run an FPL test & it came back abnormal so there is definite pancreatitis. The numbers on the right are his from March. The ones on the left are from a few days ago


20210613_203103.jpg
 

fionasmom

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Is the vet treating the pancreatitis currently? I would still strongly consider the specialist if you feel that you can do it given the varied issues that are going on.
 
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merlotandasti

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We are using 100mg/50 MG of metronidazole/ursodi & Prednisolone l to treat pancreatitis. He is definitely doing better today. He ran to me when I came home for lunch & had eaten all his food without the appetite stimulant. But for some reason, it hurts him to go poop. I don't really understand why though. Nothing shows up in the xrays & he doesn't get too constipated. Maybe it's inflammation???
 

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This was happening before, right? The rest of your news is much better though. Given what you have faced, I would keep an eye on the painful defecation which could still be part of what is going on.
 

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Have you had his folate/b12 levels tested? When was the last ultrasound done? What was checked? If he's in pain he will associate the litter box with pain so add a few more litter boxes with cat attract and start feeding only easy to digest wet food (no gums or carrageenan). You could try a balanced raw as well as raw is easy to digest.
 

silent meowlook

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Yes I do. Also I just noticed the vet did run an FPL test & it came back abnormal so there is definite pancreatitis. The numbers on the right are his from March. The ones on the left are from a few days ago


View attachment 384339
He is anemic. And dehydrated. So his anemia might be worse than it’s showing. What is the Veterinarian’s ideas on the anemia?
 
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merlotandasti

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This was happening before, right? The rest of your news is much better though. Given what you have faced, I would keep an eye on the painful defecation which could still be part of what is going on.

He's been having this problem for so long now. It has just gotten worse over the course of several months/year. We have tried using Metamucil, Miralax, laxatone, canned pumpkin (not all at once. Just trial periods of each) .... it feels like the laxatone helps him the most. His poop really isn't a bad consistency so we were always stumped as to why it hurts him to go #2. We think a lot of it has to do with his back. Initially we found he had mild arthritis a few months ago. But my cat only vet took a look at his xrays recently & found he has something similar to scoliosis that is affecting most of his vertebrae. He explained it as "his back is trying to create bone where it isn't supposed to. He said it is something genetic that happens over time. We think the position he has to take to go poop is painful for him. It never bothers him to pee bc his back is more straight. Another reason why we are using daily pain meds. I'm hoping to get him to a specialist & make a list of stuff to speak with them about, like many of you have suggested. But I am so happy he's responding to his treatment so far.
 
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