Recurrent Pancreatitis...prevention?

myrnafaye

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Does anyone have any suggestions for preventing pancreatitis from recurring? Please do not suggest a raw diet or digestive enzymes, my vet opposes both. Current diet is ID, changed over from Natures Variety, in hopes that the ID would control the disease. I would say that it has not.
 

babiesmom5

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The ONLY thing I can suggest is to keep the steroid high enough to keep the inflammation under control. Inflammation raging out of control often leads to pancreatitis.

I had a male cat with IBD, well controlled for over a year on 10mg/day(split 5 mg am/5mg pm)
His glucose began to slightly increase, so vet decreased his steroid to 5 mg/day. A couple of weeks later, he developed pancreatitis, was immediately hospitalized under intensive 24/hr care, but sadly he did not pull through.

I have two other IBD cats, initially on 10 mg/day steroid, now well controlled on 7.5 mg/day split AM/PM. They have never had pancreatitis. Bloodwork monitoring shows normal glucose.

Having lost two beloved cats to pancreatitis, I am more afraid of insufficient steroid dose to control inflammation than I am the steroid itself.

I have not found diet alone sufficient to control the disease. Raw diet and digestive enzymes can be harmful to cats prone to pancreatitis. Your vet is right.
 
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myrnafaye

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He is on pred, 5 mg. We upped it at one point and he did not do well at all at the higher dose, he was not the same cat. I have wondered about splitting the dose but I dont think that will make much difference. My vet wanted him on ID or Royal Canin digestive formula, so I switched - and here it is not even 2 weeks later, and he is sick again.
 

stephenq

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Is he vomiting or in distress? My cat we were often able to control symptoms with therapies aimed at providing relief, cerenia for nausea, sub q fluids, pepic ac....
 

babiesmom5

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It is a "balancing act" for sure. Trial and error is often required.

What dosage was the pred upped to? For how long? In what way did he not do well at the higher dose? Are you sure it was the pred and not something else?

There are different forms of steroids. There is Prednisolone, Methylprednisolone, and Budesonide is another.

Like you, I am not sure splitting the 5 mg pred will make much difference. I do have one cat presently on Budesonide whose dosage was split and it made a difference, BUT, 5 mg Pred cannot be equated with 1 mg Budesonide. They are different steroids.

I am not surprised food changes alone do not work. I am a retired Registered Dietitian with over 30 years experience. If dietary changes, or just tweaking a diet was sufficient to control IBD, believe me, I would be all over it!
 
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myrnafaye

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Stephen and babiesmom: Obi is already on pred, cerenia and pepcid. (predisolone). He is n ot vomiting. "Distress" is relative, I think; when Obi eliminates outside his box, I believe he is in some distress, although his abdomen is not necessarily painful when palpated. my vet says he may have "crossed over" on the IBD/ small cell lymphoma continuium, (he has never been biopsied but has been ultrasounded several times). I know he is an older guy. At this moment, I am concerned about his appetite (down). Should I consider an appetite stimulant, or just leave him alone? The vet also wants him to remain on ID.
 

babiesmom5

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The fact that Obi is not vomiting is good; however, he is having reoccurring bouts of pancreatitis. Not good. This indicates inflammation is not as well controlled.

I am not here to contradict your vet; however, other vets (mine included) prescribe 10 mg Prednisolone, especially at first to beat back the inflammation. Once stabilized, they then reduce the dosage to the minimum level that will keep the cat symptom free.

As I stated before, I have two cats presently controlled on 7.5 mg Pred/day. The one, however, I give 1/8 of a Mirtazapine about once a week if the appetite wanes. This has enabled her to maintain good appetite, even gain weight. You have to realize that Mirtazapine is an anti-depressant with an increased appetite side effect. It "kicks in" within 15 minutes. Cat will probably be "crazy" the first day, increased vocalization, aggitation; more normal with great appetite the second day and so on until it wears off. You have to be able to put up with some "craziness" at first to get the benefit of increased appetite. Vets say you can give it every three days, but I try to "go with the flow" of my cat's appetite, thus maybe once a week if needed. I would ask your vet about an appetite stimulant.

Some vets are prescribing a small daily dose of Cerenia to keep nausea, vomiting at bay when this is an issue. Cerenia also has an anti-inflammatory component which is helpful.

You say Obi has been ultrasounded several times. Do repeat ultrasounds show any gastrointestinal changes that would suggest he may have "crossed over" to small cell lymphoma?

The main thing is you have to keep them eating.
 
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myrnafaye

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I realize I need to keep him eating. When we increased the pred to 10 mg., he was not Obi. And he started urinating and defecating outside the box. The last ultrasound showed no changes from the one done last year. However, my vet is not a board certified radiologist. That said, I would imagine she can identify cancer if she sees it...also, apparently there is a titre on the blood chemistry panel that elevates in the presence of cancer, and that is normal. Did I mention that Obi is 17? he is. would you change any of your thoughts or recommendations based on his age? and what dose mirtazipine? yes I know what it is, I have taken it, in fact I have some at home, although it is probably old.
 

babiesmom5

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With Obi's urinating outside the box, has your Vet ruled out a bladder irritation?

While there are many good radiologists out there, I always use a very experienced Board Certified Veterinary Radiologist. His intuition and diagnostic skills are invaluable.

My cats are pushing 17. I do not think their age was a limiting factor in their treatment plan.

Since you (and/or your vet) have taken increased pred dosage off the table, your only option at this point is to treat symptomatically and hope for the best.
 
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myrnafaye

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Yes each time a UTI had been ruled out. I think this is what he does when he doesn't feel good. : ( I am thinking about asking for mirtazipine to improve appetite.
 
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