Pancreatitis Recovery Issues With Vomiting/eating?

[BijouBlackCat]

Ups and downs, ups and downs.

Vet called yesterday to inform us that the ultrasound had to be rescheduled for next Wednesday, instead of Monday. They use a mobile ultrasound specialist, and they do not allow pet owners to be present for the procedure. :\ I'm really still wondering how helpful the ultrasound will be and hoping it is worth the stress of taking her to the vet again.

Yesterday was a pretty great day for Bijou, as far as things go these days. She was going back to eat her new wet food regularly through the day and no vomit. Then today...has vomited twice and is not interested in food. I think she is constipated as well, may try out some of that canned pumpkin I bought a few weeks ago.

 

[BijouBlackCat]

Is the wet food making a difference at all in the vomiting? What brand of kibble do you use?

Not that I can tell, no. The biggest difference in reducing her vomiting seems to be Cerenia and Pepcid AC.

The wet food is Purina ProPlan True Nature, and the dry food (she probably gets ~5 kibbles on top of her wet food) is Merrick's Before Grain.

 

[BijouBlackCat]

Hoping that you get good answers on Monday. And that there are not any tumours.
Does the Vet still think it okay to continue with the steroid?

The vet said we would need to switch to a pill form if Bijou is to continue the steroid. (She got an injection previously)

 

[BijouBlackCat]

BijouBlackCat ...What did your actual Vet say about the treatment of chronic pancreatitis?
If the steroid injection did work, then could the Vet not prescribe prednisolone, or another steroid, in tablet form, or transdermal gel, so that Bijou could be treated for a longer period of time.

I am not really sure about your first question...the Vet has primarily been working with us in terms of managing Bijou's vomiting and appetite, but no longer term conversations about direct treatment of the pancreatitis. We still don't know the "cause" of the pancreatitis but Bijou is scheduled for an ultrasound next week so hopefully that is helpful...

I will definitely ask about the steroid pills, since the injection really did give her a nice "boost".

 

[PushPurrCatPaws]

Ups and downs, ups and downs.

Vet called yesterday to inform us that the ultrasound had to be rescheduled for next Wednesday, instead of Monday. They use a mobile ultrasound specialist, and they do not allow pet owners to be present for the procedure. :\ I'm really still wondering how helpful the ultrasound will be and hoping it is worth the stress of taking her to the vet again.

Yesterday was a pretty great day for Bijou, as far as things go these days. She was going back to eat her new wet food regularly through the day and no vomit. Then today...has vomited twice and is not interested in food. I think she is constipated as well, may try out some of that canned pumpkin I bought a few weeks ago.

I've just started following this thread, BijouBlackCat . You wrote that the mobile ultrasound people won't let pet owners be present during the ultrasound? What are the reasons they give for this?!

How much pain management is Bijou on, and is it consistent pain management? Have you considered subQ shots of Buprenex, instead of oral doses? Episodes of pancreatitis are very painful, and that alone could cause the vomiting, nausea, and not wanting to eat, etc.

 

[BijouBlackCat]

I've just started following this thread, BijouBlackCat . You wrote that the mobile ultrasound people won't let pet owners be present during the ultrasound? What are the reasons they give for this?!

How much pain management is Bijou on, and is it consistent pain management? Have you considered subQ shots of Buprenex, instead of oral doses? Episodes of pancreatitis are very painful, and that alone could cause the vomiting, nausea, and not wanting to eat, etc.

The reason is apparently that the ultrasound person does several pets in a row when they come in, so they can't tell us exactly when Bijou will be done? We are just supposed to drop her off in the morning. This info came from my boyfriend who spoke to the vet's office on the phone, so I may call again to confirm this on Monday.

I give her Bupe when she is particularly "meat-loafy". I did not know that there were injections. She manages to take the oral doses fairly well, and we're careful to get it on her gums and not in her mouth. Perhaps the pain is causing her issues, but I really don't know. The Bupe tends to make her kind of act strangely (e.g., hiding, limited responsiveness).

 

[cat nap]

I am not really sure about your first question...the Vet has primarily been working with us in terms of managing Bijou's vomiting and appetite, but no longer term conversations about direct treatment of the pancreatitis. We still don't know the "cause" of the pancreatitis but Bijou is scheduled for an ultrasound next week so hopefully that is helpful...

I will definitely ask about the steroid pills, since the injection really did give her a nice "boost".

Yes, ask your Vet about the steroid pills, or transdermal steroid gel, placed on the ear.

I don't want to confuse the issue, any more, since you have received great advice from the other members, but BijouBlackCat ,...why don't you ask your Vet directly...about how different...the treatment options would be if you actually did find out if Bijou had IBD, tumours, or if the 'cause' of the pancreatitis was unknown?
Basically, what you are asking your Vet, is if the 'treatment' would change, how it would change,...and what the best outcome would be, or getting Bijou to the best outcome.

Sometimes I think we don't necessarily know the 'cause' of an illness, but are still able to treat its symptoms.
(Even though, yes, I would still want to know the cause, but if our cats improve, then I'd be okay with that.)

The other question I have is about the pancreatitis blood test...the 'Spec fPL Test' (feline pancreas-specific lipase).
You mentioned in post #1, that the vets ran that test.
Is the test expensive to run again, after treatment, to see where or how Bijou is responding to treatment?

 

[cat nap]

I give her Bupe when she is particularly "meat-loafy". I did not know that there were injections. She manages to take the oral doses fairly well, and we're careful to get it on her gums and not in her mouth. Perhaps the pain is causing her issues, but I really don't know. The Bupe tends to make her kind of act strangely (e.g., hiding, limited responsiveness).

Bupe can also cause constipation, so you may have to try either miralax, or the pumpkin, you mentioned before. (pure pumpkin can either help with firming up of stools to prevent diarrhea, or relieve constipation...it must have something to do with the fibre in the pumpkin)

I just find it strange that your Vet is not the one recommending a continuation of the steroid?
Especially if it helped Bijou.

 

[PushPurrCatPaws]

The reason is apparently that the ultrasound person does several pets in a row when they come in, so they can't tell us exactly when Bijou will be done? We are just supposed to drop her off in the morning. This info came from my boyfriend who spoke to the vet's office on the phone, so I may call again to confirm this on Monday.

Well, this does make sense, then.

I give her Bupe when she is particularly "meat-loafy". I did not know that there were injections. She manages to take the oral doses fairly well, and we're careful to get it on her gums and not in her mouth. Perhaps the pain is causing her issues, but I really don't know. The Bupe tends to make her kind of act strangely (e.g., hiding, limited responsiveness).

If she is taking oral buprenorphine well, then stick with that. If she is having side effects of the particular DOSAGE of the med, check with your vet to see if you can give her just a little bit less of a dose. My last cat had 3-4 episodes of pancreatitis during her last year of life. We used Buprenex via injection, but what I did --and working with the vet too on this-- was sort of titrate the dose down to the point where she wasn't acting so very drugged out but was alert/mobile, playful and eating... signs of being more pain-free. Sometimes that may be half the dose you are giving her, or a third of the dose, etc. I guess my point is (since I, like you, have my own concerns and aversion to a "seemingly drugged-out" cat who is too lethargic and wigged out), don't avoid pain killers during pancreatitis attacks... just work with your vet in trying to find a "happier" dosage... and I think some of her symptoms (nausea, vomiting, etc) will improve.

 

[PushPurrCatPaws]

...

I just find it strange that your Vet is not the one recommending a continuation of the steroid?
Especially if it helped Bijou.

I am guessing in this instance (with Bijou), but remember that steroids can increase blood sugar and susceptibility to temporary or permanent diabetes. If Bijou is having a lot going on with her pancreas, already her blood sugar is out of whack and so, introducing long-term Pred may not be the answer (or it may complicate things). I'm not sure what considerations are in Bijou's vet's mind. My last cat had diabetes for 4 years, and when she finally got pancreatitis, the vet and I would NOT put her on Pred because it could complicate her diabetes and make things worse. It is a fine balance, sadly. And frustrating!

 

[cat nap]

I am guessing in this instance (with Bijou), but remember that steroids can increase blood sugar and susceptibility to temporary or permanent diabetes. If Bijou is having a lot going on with her pancreas, already her blood sugar is out of whack and so, introducing long-term Pred may not be the answer (or it may complicate things). I'm not sure what considerations are in Bijou's vet's mind. My last cat had diabetes for 4 years, and when she finally got pancreatitis, the vet and I would NOT put her on Pred because it could complicate her diabetes and make things worse. It is a fine balance, sadly. And frustrating!

Thank you, PushPurrCatPaws ...that makes sense.
I was thinking more of reducing inflammation and pain, as well as increasing appetite,...but totally forgot about the pancreas and regulating blood sugar, or diabetes.
This makes more sense, now.

 

[BijouBlackCat]

We're back to syringe feeding her today, she has basically zero appetite (other than some half-hearted licking at wet food this morning). On the other hand, no vomit today. My preferred vet is back in town tomorrow so I'll be calling to update her on Bijou's post-steroid decline and talk through more about the ultrasound. On we go...

 

[cat nap]

Oh, no. Poor Bijou. She was eating on her own until Saturday?
I was hoping that once she was back to eating on her own, and getting nutrients, that she'd be getting over this tough time.
I'm hoping that she's over her constipation, too.

 

[babiesmom5]

You are on a roller coaster; been there done that. Bijou was no doubt given a "short acting" steroid injection of Dexamethasone. This "jacks them up" temporarily, usually 24-48 hours or longer, maybe several days...but then it wears off and you are back to square one.

Vets will sometimes give a short acting steroid to see what happens, but they will not give a long acting steroid injection without a positive diagnosis.

I currently have one IBD kitty who got a few Dexa injections temporarily pending Ultrasound and diagnosis. Now she receives a Depo-Medrol (long acting) injection about every 6 weeks or so. She is one or two steps above feral, so cannot be medicated on a daily basis with a steroid pill. But the long acting injections keep her feeling frisky, eating well and good quality of life...and she is 16 years old!

Keep in mind that a steroid is not a first line treatment for Pancreatitis. Pancreatitis is a manifestation of an underlying cause; most likely IBD. So the key is to get the Pancreatitis under control, then treat the IBD. Since the pancreas also makes insulin, if it is actively inflamed, you may see an elevated glucose level from a decrease in insulin production. If the inflammation goes on long enough, it can result in development of scar tissue in the pancreas and eventually predisposition to diabetes. The key is to get the inflammation down which you are doing through pushing fluids, syringe feedings, control nausea and pain so the cat is able to slowly heal. This takes a while depending upon severity of the inflammation.

Pancreatitis is very challenging for sure, but you are doing all you can to keep Bijou hydrated, eating and nausea and pain free. The ultrasound should reveal what is behind the Pancreatitis and point the way toward recovery.

 

[BijouBlackCat]

My sweet girl has not been well these past few days, despite a vet visit yesterday for another steroid shot and sub-Q fluids. Last time with the steroid she perked up within the next day or so, but not this time. Her energy is still low, almost lethargic. She can still walk and jump up and down from the couch, but just lies down and sleeps the entire time. Her appetite is still non-existent, except for her long-time favorite salmon treats (and even then, she only wants ~4). No vomit for the past few days at least, but now she is peeing in random places and pooping only tiny bits.

I think this is the end for Bijou, and I hope I am not making a mistake by going through with the ultrasound tomorrow and putting her under even more stress. She has already been through so much. I'm so sad at the thought of leaving her at the vet tomorrow...I think even if they don't let me in the room I'll wait out in the waiting room just in case something happens (Silly, I know).

I love her so much and this is bringing back really hard memories of saying goodbye to my first childhood cat. I had my first cat, HoneyBee from the age of 2 - 18, and Bijou has been with me from age 10 until now (I'm 25). It's so hard to let go of our babies.

Here are some photos of Bijou, I haven't posted any yet:

 

[cat nap]

She is beautiful, BijouBlackCat .
She may be lethargic and weak because she is not eating normally. I hope that changes, and she gets her appetite back.

I hope you do find better answers tomorrow, about her pancreas, and if it's IBD, and also what types of treatments are available to get her back to better health.

 

[BijouBlackCat]

This is the post I feared having to write. Bijou's ultrasound today showed a very enlarged spleen, very thickened intestines, and thick fluid in her abdomen (probably blood). We talked at length with our vet who described this as "three strikes" in terms of the severity of these findings. The vet said the enlarged organs look to be "invaded", either with tumors or a fungal infection, and to a degree that treatment is not indicated. Bijou has continued to be very lethargic today, still no appetite, just generally seems to be shutting down.

We will say goodbye to our sweet Bijou tomorrow evening. Our hearts are broken and we have barely stopped crying. We have cancelled everything for the next day and will spend her final 24 hours giving her all her brushes with her favorite brush, salmon treats, and generally just appreciating her little presence. Our vet is so kind and she even teared up today while we talked about Bijou, it comforts me to know how seriously she takes this process.

Thank you to everyone who posted with advice, suggestions, and support for our troubles with Bijou. This is an amazing place and you all are wonderful people.

 

[cat nap]

I'm so sorry, BijouBlackCat .
Sending thoughts and prayers to you all.

 

[babiesmom5]

Oh, I am so very very sorry. When Bijou perked up after the first steroid shot, I was optimistic, but when she didn't after the second shot, my heart sank. i have had a cat not respond with the first shot, and it did not end well.

With the results of the ultrasound showing multiple organ involvement, I do think you have chosen the right course. Treatment at this stage would be fruitless. i have tried heroic measures with a cat in similar circumstances and I can tell you that things can get very ugly very fast; literally overnight and you cannot get them to the Vet fast enough to ease their suffering. You never want this for your beloved kitty.

I know your heart is breaking and I really feel for you. Rest assured that you have done an amazing job of caring for and treating Bijou. You have done all you can do...for as long as you could do it. You, and Bijou have been an inspiration to all here on this site. I hope her journey will be instructive to others here dealing with pancreatitis and its underlying issues.

I know you will be very sad closing out this chapter of your life with Bijou and shortly thereafter moving away to begin your graduate study.. Years ago, I lost my first kitty just two weeks prior to moving away to begin my advanced studies. I remember the first day of class; the professor showed a movie; I sat in the back row of the darkened auditorium and tears streamed down my face thinking of my dear Kitty Cat. While I grieved, I would often stop by the local no-kill shelter to just feel a cat in my arms again. Over the next several months, a little black kitty won my heart--she looked just like Bijou. The shelter agreed to keep her until the semester ended when I adopted her and took her home with me. She brought so much joy and graced our lives for the next 20 years.

I know today will be an extremely tough and emotional day for you. Our thoughts and prayers will be with you and your dear Bijou. Thanks for allowing us to be a part of her life...and for her to grace ours, if only for a short time. Bijou no doubt knows how very much she is loved, but give her some extra love strokes from me. I wish you peace.

 

[foxxycat]

OMG I am so sorry-never got a notification for this-so very sorry. The only thing that good came out of the ultrasound is understanding what's going on. I am so very sorry for the bad news. You did everything you could. You loved your girl and took DAMN good care of her! She knows you love her. I am so very sorry to hear the bad news. Sending you healing hugs.

Run free little one. Damn tears leaking out of my eyes-must be those allergies... RIP Bijou=you are loved and will be missed.