01/30/2012 Spitzer - pancreatitis possible

Previously

FPL came back consistent with pancreatitis, so I asked for & will be picking up, some buprenorphine for pain - 0.1 mL 2-3 times per day for 2-3 days.

Still waiting on results from upper respiratory panel.

He did throw up a little last night, before I removed the Great Choice (Sophisticat's new name) that was available from the morning. He's getting Purina Pro Plan & Fancy Feast mixed together; I plan to pick up some Merick BG turkey, if he'll eat it.

His glucose is through the roof (high 400s), even though I shot an hour early both last night and this morning to get back on schedule (early shot = dose increase). Although the vet said take it to 2.5 units, because of the higher carb & calorie contents, I think it'll need to be 3 units or maybe higher. We'll see.

The med regime is crazy - I had to draw up a schedule!
One is TID, which is difficult, as I can't always get home to do it
Another must be given 1 hour before or 2 hours after food.
ARRGGHH!

 

Good Lord...My prayers are with you. Poor kitty kitty. Poor YOU! Man I almost forget the crazy med schedules...and I only had one cat.

Poor Spitzer I hope the pain meds help.

My best,
jeanne

 

How high was the fPLI?


Yep, bg numbers goes all wacky when pancreatitis. Not one single vet or nurse at the animal hospital has been able to regulate Simba during his pancreatitises, nor have i, and the bg numbers been wonky wacky for long long, very long, after the acute p has healed.


If I had been there I've could have helped you with the different med scheduled.

 

Oh Spitzer little guy....I am so sorry you are having a rough time. I do hope you will feel better very soon.

All the meds & different scheduling my goodness. My heart goes out to you.
If we lived closer I would be over to help you out during the day. I would even get a few test in for you...lol ;-)

Jenn & Baxter
cat_pet_icon

 

Didn't get the actual #; will ask when I pick up Rx.

Here's the schedule so far:

time prescription dose frequency Notes
7:15 AM pick up food
7:15 AM sucralfate 1 mL TID must be 1 hour before or 2 hours after food
8:15 AM AMPS
8:15 AM cyclosporin 10 mg BID
8:15 AM insulin 2.5 U BID
8:15 AM metronidazole 0.5 mL BID
8:15 AM ondansetron 1/4 tab BID
1:00 PM sucralfate 1 mL TID
7:00 PM pick up food
7:00 PM sucralfate 1 mL TID must be 1 hour before or 2 hours after food
8:00 PM cyclosporin 10 mg BID
8:00 PM insulin 2.5 U BID
8:00 PM PMPS
8:00 PM metronidazole 0.5 mL BID
8:00 PM ondansetron 1/4 tab BID
10:00 PM azithromycin 0.5 mL QD
10:00 PM pepcid 1/4 tab QD
12:00 AM sucralfate 1 mL TID must be 1 hour before or 2 hours after food

 

My gosh....I got lost at 8:15 am. @-)

 

Where's the subQ fluids? They are needed for pancreatitis, as well as pepcid or some nausea med. Call the vet and say you need fluids as well.

The 3 things needed for pancreatitis are fluids, nausea meds, and pain meds.
What was the test result number for pancreatitis?

 

Oh, no, BJ!

sorry to see this...poor lil guy.

Sending the strongest possible vines, snowflakes, and healing energy for Spitzer...

celi & binks

 

I had asked for fluids when I picked him up yesterday; the vet didn't feel he needed them. I can ask again when I go to pick up the buprenorphine, in addition for getting the specific PLI result.

He does have both Pepcid and ondansetron to deal with the nausea. (see schedule above!).

The sucralfate is supposed to coat over any ulcerated areas in his intestines, if it can.

The cyclosporin is supposed to help calm any inflammation/immune response in the intestines (from what I recall the vet saying)

The metronidazole may help with inflammation and infectious irritants in the intestines.

 

NOPE wrong answer from the vet. Fluids ARE needed with pancreatitis.
And don't ASK for fluids; TELL them you want a kit 'to have on hand'. Be sure to get 22ga UTW needles if you can, but 20ga are not bad. The 18ga that most vets try to put in the kits are like hugh harpoons and I am sure they hurt the cats. The smaller guage may take longer but they dont' hurt.

 

jojo's posting on pancreatitis is below.
I would like to mention that Shadoe was having frequent pancreatitis attacks and flares but my vet put her on B12 weekly shots and she's been much better for months now.


****CHRONIC PANCREATITIS****
(or does my cat have a pepcid deficiency?)

things are going great. diabetic fluffy is nicely regulated. and then one day...just seems "off". BG numbers are higher. not eating much. maybe vomits later that night. hunched up in the 'meatloaf' position. lethargic. what is going on? you listen to the freely dispensed pepcid advice off board and after a couple of days fluffy seems to snap out of it. pepcid rocks! and recommend it to the next person on board that posts about their diabetic cat being "off".
however a few weeks/months later fluffy goes through the same episode. and again. and again. some of the episodes are worse than others. that last attack was bad and you got scared and fluffy was hauled off to vet for some basic blood work. yet nothing really abnormal on the results. is this just a normal part of being a diabetic cat? does your cat have a basic pepcid deficiency??? no.

it is estimated that <b>AT LEAST 40% of all diabetic cats</b> have what is known as Chronic Pancreatitis (CP). makes sense, the pancreas is the weak link with diabetics, in fact CP could be the causative factor on why fluffy became diabetic in the first place. simply put the pancreas has 2 types of basic functions~ the production of metabolic hormones (like the one everyone knows about, insulin) and the production of digestive enzymes. with pancreatitis it is the production of those digestive enzymes that is out of whack. when the pancreas 'misfires' and activates those digestive enzymes too early, the pancreas actually starts to digest itself and then the surrounding tissue and nearby organs, and systemic inflammation and toxin production ensues. there is a close link between CP with IBD and Cholangiohepatitis, (all three together collectively known as Triaditis).
so what now?

the best diagnostic test available is the fPLI (feline pancreatic lipase immunoreactivity ) http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml not perfect but far better than the options we had in the recent past.
it is far better to have a diagnosis (always) because then you and your vet can form a plan better than just pepcid. SQ fluids and pain management top the list. CP flare ups ARE painful...look carefully at how your cat is acting, it is not easy to tell when a cat is in pain, they hide it well. it is not just nausea that is keeping fluffy hunkered down under the chair, it is pain.
possible tools your vet might have you use:
~SQ fluids
~ pain meds
~ anti-nausea meds (hey look pepcid falls in this category)
~appitite stimulant (new med called mirtazapine (remeron) works well for cats)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed

can all be used to help the cat through the flare up. your vet can work up a treatment plan for managing your cat's CP flare up attacks.

the veterinary community is still undecided on the issue of fat content of food and whether or not it is something to be considered in feline CP. it is very much an issue in human or canine CP, however felines are very unique in how they utilize the fats (and protein) in their diets. anecdotally, some owners find that lowering the fat content (to about 35% or less) of their CP diabetic cat's diet even though it means they have to raise the carbs helps. ECID, you would have to experiment on that yourself. just a reminder on the topic of food..as a CP flare up begins cats will eat less in the days leading up to it and often not eat at all when the attack is in full force, know that it does not take many days of reduced calorie intake to make hepatic lipadosis possibly rear its ugly head, especially in a liver already compromised.

cats that are simply diabetic with no other condition going on should not need pepcid ever...if you are reaching for the pepcid again, maybe reach for the phone and call your vet instead and discuss the possibility that your diabetic cat might be one in that 40%.

links for those that wish to read about CP further:

http://books.google.com/books?id=toLXxE ... is&f=false

http://www.vin.com/proceedings/Proceedi ... &O=Generic



here's a CP treatment update from Indexx: http://www.idexx.com/pubwebresources/pd ... atitis.pdf

 

I am so sorry that Spitzer is not feeling well,
I dont know how you do it!
Spitzer is blessed to have you!
Hang in there!

 

Gayle

Thank you for the links. The Google book link in particular - "soft tan volumious stools" may be a sign of exocrine pancreatic insufficiency. Bingo. He drops these frequently, and frequently by the front door.

The fPLI was 3.3 and the doc interpreted that as supporting pancreatitis. I believe the upper normal cutoff was 3.5. In that case, he's near the upper end of normal and may be at a chronic mild level of pancreatitis/pancreatic insufficiency.

From VIN
"The clinical signs of EPI are related maldigestion & malabsorption. Typically there is a large volume of foul smelling, greasy, steatorrhoeic faeces. They range in consistency from putty-like to watery. As a consequence of the malabsorption there is weight loss and emaciation; stunting occurs if EPI commences before the animal is skeletally mature. And in response to the malabsorption, the patient typically is ravenously hungry: it exhibits polyphagia and coprophagia. It may vomit, probably because it scavenges. It often develops a dry, scurfy coat. "

- The bolded parts are evident in Spitzer.

MedVet vet would NOT give me fluids; said if he's eating, thats sufficient. He is eating an drinking. I can check with other vet, especially with regard to EPI. If he has that, he needs digestive enzymes so he can actually use the fats he consumes instead of just passing them through. Plus B-12.

MedVet wants me to wait 1-2 weeks before doing any biopsy.

 

yes, please DO check with another vet so that you have a kit on hand. And that 3.3 is pretty close to the max cutoff number.

What if you run into problems later? To me, I like to have my Tylenol in my medicine cabinet in case I need it later. I sure don't feel like going to the pharmacy when I already have a migraine, right?

As you don't have an ongoing problem, I would not suggest you go out and buy a box of fluid bags like I have in the past, so just TELL the vet that you want to BUY with YOUR OWN MONEY a fluid kit to have on hand. That's it; that's all.

I don't take kindly to vets telling me what I can and cannot have on hand in my cats' medicine chest.
Check the needles you get in the kit and if they are 18ga, tell them no, you want 18ga UTW or 20ga the largest. No harpoons for your kitty. I think the feeling is like how a blood donor needle feels compared to a thin butterfly needle when drawing blood from the back of your hand.

I hope Spitzer feels better soon.