Ben has Pancreatitis

I just left Ben at the vet with pancreatitis. I have to admit I am terrified. I love my vet for everything except managing Ben's diabetes. I kept stressing to them about him eating low-carb food when they could get him to eat and being conservative with his insulin. I'm sure they think I'm crazy. I even offered to bring in my U100 1/2 U marked syringes.

And of course the pancreatitis diagnosis has me extremely worried. I just lost one of my civvies less than a month ago. I can't imagine going through that again so soon.

 

One of our members wrote up this Primer on Pancreatitis, which you may find helpful.

 

HUGS and HUGS Lisa - pancreatitis stinks!

Headbutts Ben - prayers for you...

 

Healing vines to Ben. Can you take your own food to the vet's? That is what I do and I stress to them that his food is ALL they should give him.

 

Hi Lisa,

I'm sorry to hear about Ben's pancreatitis. Been there, and I really feel for you both.



I was in bits when Saoirse had the really bad flare last year. Because I'm at home all the time (disabled) I was able to nurse her through it with just telephone support from the vets. Otherwise she would have to have been hospitalized. My darling girl was so sick, and I was beyond frightened but once I got her onto the right supportive meds and eating again, she recovered very well.

Kitty pancreatitis is really tough because you need to make sure that your queasy kitty continues to eat and drink. Feeding very small meals very frequently can help. Also, right now the main thing is to make sure that Ben eats something. The right food for the time being is anything that gets nourishment into him. If he won't eat his normal low carb but will eat something else, then that can be the best way to go. Some cats are very fat-sensitive. You may find that Ben might do better on a lower fat (but possibly higher carb) food temporarily. There is the option to work the insulin around his other medical needs, so you could discuss that with your vet.

When Saoirse was at the height of her bad flare last year, my vets recommended temporarily feeding her chicken breast. Although not a complete food, it is easily digestible (assuming no allergies) and it can do the job of keeping body and soul together until the supportive meds and other treatments become effective. I gently poached skinless chicken breast in water (nothing added!), minced it finely and also I kept the poaching broth. I fed Saoirse small amounts of the minced chicken with a 50:50 mix of broth and water to keep her hydrated (1 meal per hour of c. 1 level tbsp minced chicken, and 1 tbsp each of poaching broth and fresh water) . Do you have timed feeders at home? It might be worth looking into them for when Ben gets home; they make it much easier to manage feeding tiny, frequent meals. As well as medical treatments, simple things like raising Ben's food and water bowls can help a lot with nausea problems.

Here are two information sources that I found to be invaluable:-

IDEXX Pancreatitis Treatment Guidelines

IDEXX Pancreatitis Treatment Guidelines (points to new, live URL on IDEXX website).

Nausea and Appetite Problems (from Tanya's Site) - this helps you to learn the behavioural warning signs for when a cat is experiencing nausea/acid stomach.

Saoirse had: a course of B12 injections (really gave her a boost - levels can be low in pancreatitis kitties); a Cerenia injection at the beginning of the flare for nausea; ondansetron for longer term nausea symptom management (saved her life!); cyproheptadine for appetite stimulation (during height of flare - gentler than mirtazapine and does not carry risk of inducing serotonin syndrome); famotidine for stomach acid.

On the subject of stomach acid, I discovered that if Saoirse was forced to fast for more than 2-3 hours she would vomit up clear white or yellowy foamy liquid (the diagnosing vet tried to force her onto only two meals a day ). This problem subsided after a few months on her maintenance meds (ondansetron and famotidine - the latter mostly because she has early stage renal insufficiency).

Please let us know how things are going when you can. Pancreatitis flares can be really scary - kitties can look soooooooo sick, but food, fluids, and the right meds and supplements can really turn things around. Even my vet was astounded at how well Saoirse recovered - she looked radiant with health a couple of months after the start of the flare (the low carb, species approprate food and the Lantus worked a wee miracle on her!).

We're all here to help, even if it's only with a bit of moral support. It's definitely not something to go through alone; I was in pieces when Saoirse was really bad, and I will be forever grateful to the FDMB members who propped me up and helped us to get through it. Have some more and also sending healing vibes and soothing scritches for Ben }}}}}}}}}}}.



Mogs


EDITED 3 January 2016

- updated link to IDEXX treatment guidelines (document moved on IDEXX site).
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Thanks for all the advice and support. One of my civvies had pancreatitis about six months ago. She was way sicker than Ben is. I think I'm just more worried because of Ben's diabetes. Got a call from the vet. Ben is looking better and ate half a can of food this morning. She wants him to stay the day for one more dose of IV meds then I can pick him up this evening. She said she wants to get him home as soon as possible because I'm the best at managing his diabetes.

 

Vines for Ben. Kudos to the doc for knowing you are best for treating the diabetes. Will they continue to help you at home for the pancreatitis?

 

Hi Lisa,

I'm very glad to hear that Ben is feeling better and due home later today.

I can understand why you're worried about Ben having both pancreatitis and diabetes. When Saoirse was really bad last year it was a real white knuckle ride worrying about giving her insulin when she had appetite problems. Will your vet be sending you home with a supply of supportive meds?


Mogs
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Ben is home. They sent me home with three doses of Cerenia. He's eaten a little bit of cat food (a couple tablespoons) and a bit of pork chop.

 

Great news, Lisa. I bet you're both happier now. I'm glad to hear he's eating a little bit for you (always such a relief!).


Mogs
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I'm heading to the store for some chicken. It's always been his favorite. I have admit I'm a little scared at how little he eats. I can manage his sugars but worry about managing the pancreatitis.

 

Well the chicken is a bust. He licked a little gravy off some gravy lovers food. He drank lots of water out of the faucet so I know he's hydrated. But I'm worried about the small amounts of food he's consumed. I wonder if he'd be better back at the vet on an IV. It's 1AM here so I'll wait out the night and see what he is like in the morning.

 

Hi Lisa,

How are you doing? I bet it was a long and worrying night. I remember those. I'm sorry that Ben wouldn't eat the chicken for you.

I'd be inclined to suggest to you to ask your vet today for more supportive treatments to help Ben to eat (especially as it's Friday). I was in a desperate state trying to get Saoirse to eat - it was awful. The following things really turned things around for Saoirse:

* Cyproheptadine for appetite stimulation. (She got 1/8 tablet 2-3 times a day at the peak of the flare - saved her life. Much gentler action than mirtazapine and doesn't carry the risk of serotonin syndrome.)
* Ondansetron BID (Saoirse needed 2mg BID for a while, but normal dose is 1mg BID. She did get a Cerenia injection first up but the ondansetron seemed to help her better on an ongoing basis. Generic is much, much cheaper in the UK - I assume that's the case across the pond, too.)
* Famotidine (1/4 of a 10mg tablet as needed - maximum once a day - taken separate from other meds to reduce potential absorption problems).
* Course of weeky B12 cyanocobalamin injections (These gave Saoirse a real boost and seemed to help her appetite a bit.)

It might be worth asking your vet about some buprenorphine for pain relief.

Let us know how you're doing. Sending appy stimulant vibes for Ben and some for his mama bean.


Mogs
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Ben is impossible to pill when he is feeling good. Can't imagine it would be any better when he is sick. But I'll be talking to the Dr today.

 

Ben just stole a bite of sugar cookie from me. I told him that was not what Mogs meant when she said any food.
I had to go into work for four hours and while I was gone he ate the quarter can of food I left out. And then ate about a tablespoon of food with his morning shot. I'm hoping that's a good sign.

 

Bad kitteh!!! Drop the cookie! Step away from the megacarbs!!!

I think it's very encouraging that Ben's nibbling away at some food under his own steam. When Saoirse was really bad I couldn't get her to eat anything without the meds. I still think it's a good idea to ask the vet about giving you some squirrel stock of anti-nausea and appy stimulant meds, especially to tide you over the weekend. If Ben doesn't need them you don't have to administer them, but if he does they're on hand. One thing I have found when learning how to manage Saoirse's pancreatitis is that having the meds on hand to respond immediately to even slight worsening of her symptoms has helped us to avoid inappetence problems quite successfully.

FWIW, I crush Saoirse's ondansetron and give it to her in some food with freeze-dried chicken crumbled over it. Maybe you could try putting a crushed pill into a teaspooon of the gravy that Ben liked yesterday? I know the carbs would not be the best, but if it helped you to get enough doses of the anti-nausea treatment into his system to start eating more normally and then you could try crumbling it into his normal food? Another alternative would be injectible Cerenia to cover the next few days. I don't know whether it might make a difference but the 1/8 tablet doses of cypro are miniscule. You might be able to do the gravy trick with that, too, if needed.

Sending more eat-your-yummy-fudz vibes for Ben and more for you. Looking forward to hearing how your chat goes with the vetty bean.



Mogs
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Here's what I have for the weekend...
Cyproheptadine compounded into a liquid
Cerenia injections
Injectable buprenorphine

Hopefully that will get him feeling better.

He ate a whole can of gravy lovers FF at AM+6. Which is fine because his BG was 61. Now he's sleeping on the bed with the electric blanket on low. I hoping he is more lethargic this afternoon because of the buprenorphine (which I gave at noon)

 

All Rx'd up and not a pill in site. Good stuff, Lisa.

Insulin and inappetence is a very stressful combo with which to be contending. It's great news that Ben ate the FF meat as well as the gravy. I'm really chuffed for you both; I'm sure it must be a bit of welcome relief for you, Lisa.

The bupe can be quite sedating. Saoirse's quite med-sensitive and a mere 0.1ml sublingual dose makes her a bit snoozy (larger doses tended to wipe her out completely). FWIW, cyproheptadine can cause drowsiness (it's an antihistamine). Too high a dose of cypro can also depress mood somewhat. When Saoirse was being treated with both cypro and bupe, I found that the lethargy was greater than if she was on one or the other.

Is Ben drinking OK for you?


Mogs
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Ben's drinking pretty well. I have a fountain in the room where he is spending most of his time. It's the perfect height for him to drink without leaning over. And when he's out with the civvies, I turn on the faucet which he loves drinking out of.
Over all I'm encouraged at his response today. Hoping for continued improvement. And not just to prove to my vet that letting him come home was the right thing to do.

 

Great to hear that he's drinking enough. Hydration was a real concern for me during Saoirse's really bad flare because she stopped drinking from the water bowl after the switch to wet food. I had to add water to all her feeds (and I still do).

On home nursing, our vets were really supportive. Our main vet at the practice said that, when it's feasible, being nursed at home can help speed a cat's recovery because it will remove the stress of being in the hospital. I used secondary monitoring to help me keep a check on Saoirse's fluid input/output. I also keep a diary of Saoirse's clinical signs alongside her BG data. I shared the link with our vets and they did consults over the phone for us. It worked really well (not least of all because I'm agoraphobic).

Here's hoping little Ben will have an even better day tomorrow.




Mogs
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The vet I've been working with for Ben's pancreatitis is pretty new. So she's somewhat comfortable with me doing a lot of this at home. Much more so than some of the old school vets that are at that same practice.

Thanks you again for your support. I'll keep you updated on our progress.

 

Progressive veterinary support is invaluable. I'm glad you've got a good vet in your corner.

I'm glad I'm able to help a little, Lisa. I look forward to reading Ben's next progress report. Please give him some get-better-soon scritches from me. And be sure to try to grab what rest you can for yourself.




Mogs
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I've been following Ben's story here because my Miles is hospitalized with pancreatitis. Maybe some of these suggestions will help my sweet boy also. Good luck and I hope he sees continued improvement.

 

Good luck to dear Miles. Ben is doing much better than my civvie, Bella did. She took days to start eating again. I would go to the vet and sit by her cage trying to get her to eat. It started with licking chicken baby food off my fingers then a tiny bit of cat food. Never underestimate your support and comforting smell. When she wouldn't eat for them, she would at least try for me.

 

We seem to have the nausea/vomitting thing under control. But is there anything I can do for the diarrhea? His stools are still completely liquid.

 

@marniepaul & miles -

Hi Marnie,

I'm very sorry to hear that Miles is having a pancreatitis flare as well.

These two links I posted earlier have proven invaluable in helping me to nurse Saoirse and also to manage her condition day-to-day (she has chronic pancreatitis):

IDEXX Pancreatitis Treatment Guidelines (up-to-date link)

Nausea and Appetite Problems (from Tanya's Site) - this helps you to learn the behavioural warning signs for when a cat is experiencing nausea/acid stomach.

There's also a Yahoo support group for feline pancreatitis. I did register with it but because of my cognitive difficulties (I have PTSD) I couldn't cope with the mail-in format. I have heard many recommendations for the support there from FDMB members.

Secondary monitoring is invaluable when looking after a kitty with pancreatitis. Keeping a daily journal of clinical signs, food, pee, poops, etc. is helpful when looking after a kitty during a flare, but it's also worth its weight in gold as a historical record. I can't tell you the number of times I've been helped by going back over Saoirse's journal when we hit a glitch. (Have a look in her spreadsheet for last year - link in my signature.) If you look at member @BJM's signature line, it contains a link to her very helpful Secondary Monitoring tips.

I hope that Miles feels better and comes home very soon. Maybe start a thread for Miles on Feline Health so that we can follow his progress?



Mogs
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For diarrhea, you can add 1/8 to 1/4 teaspoon of psyllium powder or 1 teaspoon of plain pumpkin (not pie filling) to help soak up excess moisture and give the feces form.
Note: if the feces are pasty/light, really foul smelling, and voluminous, discuss with your vet the use of some pancreatic enzymes. Pancreatitis can interfere with the normal production of these.

 

Hi Lisa,

I'm very glad to hear that Ben's nausea has reduced and that he's eating a bit for you.

This is so true. I lost my darling girl, Danú, to hepatic lipidosis. She was hospitalized (jaundiced). The vets did not respond appropriately with any necessarily aggressive intervention to get food into her, and they would not let me stay with her to try to encourage her to eat. She was there for the best part of a week before I lost her. I've never been able to forgive them; nor myself. (We're with a different practice now.)

After losing my Danú Lovey Girl like that, I was frantic when Saoirse was struggling to eat last year. I was so relieved that our current vets were cool with me nursing Saoirse at home. They did all I could wish for with telephone support and keeping her trips to their surgery to an absolute minimum so as to eliminate as much stress as possible for her.

Oh, the diarrhoea!!! At one stage last year I despaired of Saoirse producing a solid bowel motion ever again.

Flagyl (metronidazole - an antibiotic) can be used for diarrhoea but it apparently tastes absolutely foul. Our vets prescribed Stomorgyl 2 for Saoirse. It contains metronidazole plus another antibiotic whose name escapes me. I don't know how you'd manage it because it's a pill. Other things that may help are probiotics, (e.g: Fortiflora (careful - may worsen nausea); natural yoghurt) or canned pumpkin (natural, not the pie filling!). Our vet prescribed Pro-Kolin for Saoirse. It's a kaolin paste with probiotics. It helped stop the liquid runs, but other than that the best results she got were squidgy, kitty-sized cowpats of poop. I used to put the paste onto her forepaw and she would - grudgingly - lick it off. It helps to give food that is easily digestible. I fed Saoirse just the minced home-poached chicken and broth through the peak of her flare. Some people give pancreatic enzymes (especially if the bowel motions show signs of exocrine pancreatic insufficiency - unusually whiffy, pale in colour, possibly 'marshmallowy' in texture). Your vet may be able to recommend something.

I hope you managed to get some bit of rest last night, Lisa.


Mogs
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Sending healing vines to Ben and Miles!
Agree with Mogs and BJ. The diarrhea is probably fiber responsive. So, I would try psyllium or pumpkin first. Just be sure he's drinking enough. Dehydration will only complicate everything. And I might have missed this but I would syringe feed if he's not getting enough calories. Hepatic lipidosis is not something we want anyone to have to deal with!
Sending hugs to Ben's and Miles' humans too!
Edit: Flagyl can work miracles sometimes too... as Mogs mentioned.

 

Thank you for this - I will keep it in mind. My threads are in the Lantus/Levemir group.

 

Update on Ben. He is eating a couple cans of food a day spaced over several small meals. And I haven't given the appetite stimulate since yesterday morning. He's drinking water plus I'm adding water to the food to make it "cat food soup". His stools are still runny but they aren't "fluffy or particularly pale". He ate some pumpkin last night and I'll give him more today. He won't eat canned pumpkin. Only the pouches of pumpkin that I found in the cat food aisle at PetCo. I think that tonight/ tomorrow will be telling on how he is. He got his last shot of Cerenia last night and the bupe should wear off tomorrow morning.

 

Hi Lisa,

I'm really pleased to hear that Ben has been eating - and without the appy stimulant. That sounds really encouraging. I'm sure you must be very relieved; pancreatitis is the pits. I hope the kitty pumpkin will help with Ben's diarrhoea.

FWIW, once Saoirse started eating without the help of the cypro she still needed anti-nausea support. This lessened a good bit, but once her insulin was withdrawn at the end of last year her nausea got worse so she has been taking ondansetron regularly since. I've read here about a number of cats whose pancreatitis symptoms seem to have got worse when they went OTJ, so I thought it worth mentioning to you. (I actually wanted to put Saoirse back on a maintenance program of insulin microdoses since last February but didn't get the support for it from the vets; it has been a long, tough year watching her clinical signs deteriorate without it, eventually falling out of remission. She went back on Lantus on 26 November. Thankfully over the last week or so her hiding behaviour has markedly reduced, even though her numbers still aren't great.)

Will your vet be able to give you some anti-nausea and pain medication to see Ben over the Christmas period? Even if you don't need to administer it, it's invaluable to have squirrel stock at home. In particular, being able to address nausea problems promptly makes the world of difference and helps head off any potential inappetence at the pass.

Scritches and .


Mogs
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Hi Lisa, Mogs, and Marnie - I pm'd Lisa and she referred me to this thread. Although not formally dx, Murphy has had episodes of pancreatitis, more common now with diabetes - he is intolerant to all forms of wet food, and I think it is due to the fat content in wet food. can this be possible? Also, I thought the dose for cypro has 1/2 tablet q12 hours - maybe I've been giving too much. during his flare a month or so ago, his stools definitely showed evidence of exocrine insufficiency, but I read somewhere that it is dangerous to give pancreatic enzymes during a flare as they could end up digesting the pancreas. Could that be true? My vet isn't familiar with ondansetron, only cerenia. Cerenia seems to work great on a prn basis, but I wonder if I should try ondansetron if that could be given daily. The information in this thread is invaluable. Thank you very much . How do you join a yahoo group? Do you need a yahoo account?

 

Hi Carol,

Sorry to read that Murphy is troubled from time to time by pancreatitis.

There is some debate in veterinary circles about the effect of fat in the diet of pancreatitis kitties, but I think the general view in the Yahoo group is that dietary fat does cause a problem. I think perhaps some cats may be more fat-sensitive than others. You do need to sign up for a Yahoo email account to join the Yahoo pancreatitis group.

Not heard of this before. I suggest asking your vet about this. Also, at the EPI link above you should find a link on the destination site to their support group. Not sure of the quality of support there (no experience of using that forum).

I first heard of ondansetron from members here. Our vet had heard of it but because the branded version (Zofran) is hideously expensive he had never prescribed it before. Initially he gave Saoirse a Cerenia injection then Reglan for home use, but Reglan isn't much cop for cats (not enough of the receptors targeted by Reglan aka metoclopramide; and Reglan can also screw up the dopamine system). Our vet gives me a written Rx for ondansetron and I get it filled at a local pharmacy (it's a human med). It was a game changer for Saoirse's treatment. I'd suggest maybe sharing the IDEXX document with your vet - it's a very good basis for discussion when choosing the right course of treatment for pancreatitis.

Our vets prescribed 1/8 to 1/4 of a 4mg tabled of cyproheptadine q 8-12. Saoirse was quite groggy on the 1/4 tablet. 1/8 did the trick for her. I've read about cypro having a mildly depressive effect on some cats at the higher dose (it affects serotonin levels). Saoirse only needed the cypro for a short while during her bad flare last year, and usually 1/8 tablet q 12 was sufficient to keep her appetite ticking over, and I gradually tapered it down (longer time between doses) as her appetite improved. I think there were only 2 or 3 days when she needed 3 doses per day. Perhaps have a chat with your vet about fine tuning Murphy's cypro dose?



Mogs


EDITED TO ADD:

Saoirse gets GENERIC ondansetron (great with Bristol Laboratories' version; really badly constipated on the Cepla version).
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This is not true. Eventually giving enzymes during a panc flare might become standard of practice. The pancreas is leaking into its surrounding area, digesting itself, but the enzymes you're giving end up in the gut where they are actually supposed to be.

 

Well, that's what I was thinking too. I'll try to find where I read that - I was shocked because I had been giving Murph the enzymes when his stools were pasty and bulky and horribly smelly - but I read that then I stopped. Murphy is unable to tolerate canned food - every single brand and variety gives him either a flare up of IBD and/or pancreatitis. I think it may be the fat content of wet food - does anyone have any experience with that. I currently am trying to give him small amounts of tiki cat chicken since it has so little fat, but he isn't crazy about it. What amount of fat would be considered low fat? Does anyone have recommendations for a low carb/low fat food I could try? I'm at my wits end and his sugars are so high on dry (even Evo) - he currently won't eat Young Again

 

Some of the Weruva flavors have lower fat, but the texture is the same as Tiki Cat. In the veterinary literature, it sounds like they think high fat is a bigger issue for dogs with pancreatitis than it is for cats. With IBD though, I think it would be possible for the fat to make a difference.

 

Thanks for all the info, Mogs - it's extremely helpful to me
I really need to find the wet food he will eat and doesn't result in either IBD and/or pancreatitis flare

 

thanks - I do think that fat might be one explanation for his intolerance to wet food - I am going to check out Weruva - I puree the tiki cat so I can do the same for Weruva