8/11 punkin amps 186 +6/172 pmps 210 Pancreatitis

yesterday

at least now we know why he feels so crappy. poor little guy. the range for pancreas values are
less than 3.5 normal
3.6-5.3 gray area, possible pancreatitis
over 5.4 likely pancreatitis - punkin's fPL was 11.6.

for some reason, i had assumed that cats whose diabetes was caused by acromegaly would be kinda unlikely to get pancreatitis. i assumed their pancreas basically works, although after high blood sugar for a period of time, nobody's pancreas works. Dr. Rand's study showed after 3 days at 500+ BGs the beta cell output went to almost nothing. anyway, yesterday Leo got the diagnosis, today Punkin. so apparently acro cats are not exempt.

the vet said that this could be the reason for his increased BGs and why we've had to go up in dose. I would say he's been off, not feeling up to speed, since he had the dental on 5/2. we know he had the C Diff with 2 weeks of AB for that. We're going to take in another stool sample tomorrow to get checked to see if the C Diff is resolved or not.

for now, the vet has him on 2ml Bupe twice a day,
2.5mg Pepcid once a day
as much water in his food as he will tolerate
and Tuesday we've got an appt to get started on sub-q fluids. good thing Marje did that video!!

on the good side, the blood test showed an improvement in both BUN and Creatinine - both are back into normal range. so the food switch to a lower phosphorus has really helped! His urine is still dilute, so we know his kidneys aren't 100%. He shows some increased white blood cells - could still be C Diff, could be something else. He has very high CK, which she said shows muscle tension - could be anxiety, could be arthritis - kinda a scratch your head thing. The range is 64-440 U/L and he was 1398. Thyroid normal.

Time for me to go review Jojo's post on pancreatitis. except now it's gone with the link to the old server severed. anyone know how to retrieve that info or if it's somewhere else?

i'm relieved to know what's making him feel so icky. he is still eating, fortunately. the vet thought it may have been simmering for some time.

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

Poor punkin! No wonder he doesn't feel good. He has sure been through a lot and so have you. (((((Julie))))) and I'd hug punkin too but he probably wouldn't like it. Sending healing energy to your guy and paws crossed for a quick recovery.
Liz

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

Poor Punkin! Sending lots of healing vines down from Hermiston tonight. At least now you have a better idea of why his numbers have been higher lately. So glad he still has his appy. Pancreatitis would be a hard one to think about if he is still eating, so good job on getting those tests done.

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

awww poor punkin boy!! He just hasn't been feeling well in forever! :sad: Give him light scritches from us ...

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

Awww... poor Punkin :sad: Hope the meds will help him feel better :YMHUG:

Here's Jojo's CP post:


****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=to...onepage&q=feline chronic pancreatitis&f=false

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6623&Category=1004&O=Generic



here's a CP treatment update from Indexx: http://www.idexx.com/pubwebresource...pec-fpl-treatment-for-feline-pancreatitis.pdf

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

(((Julie)))!!!

I'm so very sorry that Punkin has just had such a rough time lately. And now pancreatitis! Poor sweet boy!!!

I'm working on a new post updating JoJo's on pancreatitis and I did a search for it and did find a few things actually written in condos.

Here's one although it's not the full CP post she did:

Here are a couple links:
2010WSAVA
Treating Feline Pancreatitis
Roundtable on Feline Pancreatitis

sending healing vines and I'm glad you will be able to use the video. Let me know if I can help...

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

Julie, sending healing vines to sweet punkin! Now you know the diagnosis and can treat it but so sorry punkin and you have to deal with it. It seems a few kitties just lately have been diagnosed with the pancreatitis. We'll check on you both tomorrow, Hugs.

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

Awww Julie and Punkin I'm so sorry to hear about this.

I've come to the realization that maybe Leo should be on Pepcid forever and that this is something he will always have. Now we have had 2 diagnosed episodes with a third as a strong possibility. I'm looking into weekly B12 shots as well, the FB feline acro group swears by it. No vets around here seem to have heard about it so I emailed dr. Timian about it.

On the bright side subq fluids were super easy to give if you follow Marje and Gus' video!

Did the vet say anything about cerenia or something like that? I got a whole vial of it yesterday, it's pretty pricy ($120) but considering how often Leo has flare ups it will be worth it in the long run.

Hugs to you both. Have a good evening and feel better soon Punkin.

 

Re: 8/11 punkin amps 186 +6/172 Pancreatitis

Hi Julie,
So sorry to hear about the pancreatitis. Poor Punkin. Now, however, you know what is bothering him and you can begin to deal with it. You might think about joining the Yahoo Feline Pancreatitis support group: http://pets.groups.yahoo.com/group/Feline_Pancreatitis_Support/
There's a lot of information there. I joined when Rusty was diagnosed with Pancreatitis this past spring.

Golly, it's always something, isn't it?! Punkin, we are sending you lots and lots of healing vines and the KTSS will be along this evening with some good chicken soup.

:YMHUG: :YMHUG: :YMHUG:

Ella & Rusty

 

you guys are such angels! thank you for finding the post for me. i had it bookmarked on my browser and have given it to others many times, but reading for yourself is always different. the bookmark didn't work - i suppose it went to the old board. at least that's what it looked like. i'll read those links later this evening when i have a chance.

the vet had a "plan" on the B-12. it's something like weekly for a few weeks, then bi weekly, then monthly. i'm glad to hear it's on the list that others have had success with.

i'm really glad about a couple of things (wearing my Pollyanna persona) - he's eating pretty much fine. he refused last night when he went low and i'd given him a lot of high carb, but in general, his appetite has been decent. i suspect that's the reason the vet didn't suggest cerenia or ondansetron.

he's not vomiting either. although he did a few watery things and one food vomit a couple of weeks ago.

and if this is the reason his BG is increased, it means the tumor hasn't revived! wahoo and yippee! i was thinking that the SRT hadn't gotten everything, and honestly, i'd rather deal with pancreatitis than the tumor possibilities.

oh, and btw, the vet said the dilated pupils is from the bupe. although i think i saw them dilated a couple of times before we restarted the bupe, so the tumor still could be causing that. but perhaps it doesn't mean that the tumor has grown any bigger.

thanks for your support. i don't know how people can manage FD without a support group. i appreciate all of you. i'll tell punkin the KTSS will be along - you know he likes chicken anything! :lol:

 

I'm so sorry about the DX, but at least you do have an answer now, and can work on fixing things.

Recently my Zen had BW done because he had an ulcer on his tongue. He also had a very high CK, and our vet basically said the same thing your vet did: it's not really connected to any disease, and it could have been stress or the needle stick or just "because".

Feel better, sweet Punkin!!

 

Ditto what Amy said - dx isn't fun, but it's something you can hang your hat on and treat. Better than not knowing or not being able to figure it out!

SO LOTSA chicken soup and healing vines to Punkin to get through this really quickly... and maybe leave it behind!

Hugs to you both!

 

Tobes is ready to help with the massage when the KTSS crew shows up!!

 

Sending healing vines to Punkin!
Get well soon boy!

 

Poor Punkin! I'm sorry you and Punkin have to deal with this Julie. It's not fair. That poor boy has had more than his share of not feeling well lately. I hope he starts healing quickly once he has his subq and all the meds on board. He's been so brave.

I'm sending healing wishes and strength vibes for you both. Please give Punkin a hug for me.

Hugs,
Melanie & Racci