? Does Sebastian need Prednisolone?

I see Prednisolone come up a lot in threads around here related to cats with chronic pancreatitis and other issues and I'm wondering if it's something I need to discuss with my vet about getting Sebastian on. For those that haven't been following him, he was in the hospital for a week back in November with his first p'titis diagnosis and since then it's been on and off bouts of vomiting and most recently diarrhea from suspected IBD. We didn't do an ultrasound or any of the more invasive IBD tests but the vet did do a physical exam and said the bowels felt thickened. So at the very least it seems he has inflammation of the bowels and pancreas.

I don't trust my vets as far as I can throw them to be up to speed on all the treatments, so between Sebastian's chronic p'titis flare ups, possible IBD, difficulty in managing his weight, and general up-and-down insulin requirements, should I be requesting he get on Prednisolone?

 

Prednisone can cause diabetes in cats. I know it would help problems like pancreatitis and IBD. I hope people more experienced reply. My vet said we should avoid it, when my cat was having a possible pancreatitis flare.

 

Hi Justin,

First, was whats called a SNAP fPL done in the office? A subsequent SPEC fPL should have also been sent out to confirm the results of the SNAP fPL done in office. These tests are noninvasive & are one of the essential tools & one of the most specific tools vets have to determine if there is actually pancreatitis. The test has strong specificity for moderate to severe pancreatitis cases. Mild cases tend to have less specificity, but again, its used in combination with other important info like clinical symptoms as well as ultrasound (ultrasound is less accurate as far as knowing specifically that its pancreatitis vs another issue causing the changes seen on ultrasound).

Here is a link for info about the SNAP & SPEC fPL & it also provides some info about pancreatitis:

https://www.idexx.com/files/spec-fpl-treatment-for-feline-pancreatitis.pdf

It is not uncommon for cats to have inflammation of the intestines, pancreas & liver-called Triaditis. Some cats start with inflammation of only one organ & then others become inflamed with time. Not all with have triaditis, but again, its not uncommon.

My cat was diagnosed & treated by a top U vet clinic & after diagnosis was confirmed, he was started on Prednisolone, Cerenia, a pain medication & fluids. Slowly each medication was decreased and discontinued as he improved. Unfortunately, he was never able to be titrated off the prednisolone despite several attempts to do so. Pancreatitis is an extremely painful disease & therefore, I was strongly advised to find the least effective dose where my cat was comfortable & clinically stable vs. continuing to lower the dose & crashing him. There are felines with immune mediated pancreatitis & prednisolone is key to treating them. Pain meds don't manage or stop inflammation & Pred does. There are some current studies currently about to begin to see if using combination immunosuppressive drugs WITH prednisolone are helpful with these cases, but in the meantime, there are limited options for cases of more moderate to severe chronic inflammatory pancreatitis.

If he DOESN"T have it based on the fPL, then a drug like buprenorphine (pain), could be helpful. You may also need Cerenia (anti nausea). You could also mention this as an option to try but it may not work because again, it doesn't treat the inflammation.
If he DOES have pancreatitis & Bupe is not an option or you try it & it doesn't work, do NOT be afraid of prednisolone because it will get things under control more quickly & many times, once the cat is stable, you are able to slowly decrease the dose & get them off of it. For some felines, a small every other day dose works amazingly well if they need it for maintenance.

Chronic inflammation that is not managed WILL make BG difficult to control, just like pain & stress does, so its not uncommon to see the issues when the inflammation is not treated. One of my team even told me that DECREASING my cats pred could actually INCREASE his BG vs lowering it IF it results in an increase in his inflammation. That info was a game changer for me!

My cat continues to be on prednisolone. Taking him off is NOT an option (believe me, we tried multiple times....& pretty much made our cat miserable in the process). It would be nice if it was simple/easy & there was another option for my cats illness, but right now there is not & so I play the hand that is dealt & focus on making sure my cat is not in pain & has quality of life. Unfortunately, the knee jerk reaction is for people to go after the prednisolone when they see DM, but the reality is pancreatitis causes destruction of the organ & thats more than likely the cause of the DM vs the prednisolone. Even IF the prednisolone plays a role or is to blame, its a complication of the disease & you manage it because sometimes there just isn't another option. Its just not black & white. Sometimes you have to manage in the gray area

I hope this helps. Its definitely complicated when the pancreatitis is immune mediated, meaning there isn't one flare thats managed with meds & then its stable for awhile, but it is able to be managed !

One last note, DIET, is important. Moderate to low fat is key. One thing I've found is many of the high protein, low carb diets are LOADED with fat (& calories) which will definitely aggravate things. And fiber, although given a bad wrap, is also important. Carbs are not carbs! Finding a food with low to moderate fat & even some good carbs (fiber) is helpful not only with gut health but also with regulating BG !!

Hope things improve! Hang in there!!

 

Yes, both have been done. When he was hospitalized in Nov he was confirmed for pancreatits, I know they did an ultrasound and I assume they did a SPEC fPL however I don't have results from that visit handy. I do however have follow up results from Feb that has his SPEC at 7.1, and I also know a snap was done when I took him to the vet for his first bout of vomiting after the initial diagnosis and was positive.

When he was discharged from the hospital I wasn't given any of the medications you listed, just some antibiotics, anti-nausea, and appetite stimulant. I have since gotten prescriptions for Cerenia (has no effect on him), sub-q fluids which I administer as needed whenever he's having vomiting or diarrhea, and most recently Buprenorphine. However all of those were given on my request, based on information from these forums. None of the vets at either the hospital were he was diagnosed and treated for pancreatitis or my local vet who frequently see him for vomiting and diarrhea have even discussed pancreatitis treatments directly, only symptom management.

I feel like this may be what's going on. There is no inflammation management going on and his insulin dosage has been going up and down and at times doesn't seem to respond to insulin dosage increases.

He definitely had DM first. He was diagnosed with diabetes 5 years ago and didn't have any issues with pancreatitis until this past year.

So let me ask, are there any complications with prednisolone while being diabetic? My local vet has said that steroid use is generally avoided for diabetic cats but it's sounding like maybe this is the exception?

 

You will just have to monitor the BG & it sounds like you are already doing that. It is avoided if & when possible because it can effect the BG. One cat can be really effected while another not so much. Again, maybe a low dose for a period of time will get everything under control & you will be able to get him off of it. You may or may not have to adjust the insulin. Maybe the decrease in inflammation will cross out some/any of the effects of the Pred. if it does increase the BG. I'll say some prayers that happens for you!

 

Hey, check the reply box you sent above because some of my responses went into that! Don't know how or why but they did & all I see on the reply is the "you will have to monitor the BG.....". I responded to your other points, but they are in the box attached to my reply!!

 

Thanks for the input. It sounds like it's just a balancing act between whether it's going to help or not, and with Sebastian's other issues like possible IBD it'd probably be difficult to tell. I think at this point I'll just continue my current plan which is to try and treat the IBD first and see where that gets us in regards to the bouts of vomit and diarrhea.

We've also tried Odansteron, giving him both that and Cerenia. Didn't have any effect on stopping his vomiting. At our last visit I got a couple syringes of the injectable Cerenia to see if that's more effective but he hasn't had any vomiting since I haven't had an opportunity to try it. I also have Mirtazepine that we've tried when he stops wanting to eat but that didn't have any effect either. Kinda made him hyper for a couple hours right after giving it to him but that was about it.

 

You are welcome! I hope the injectable works better for you...or that you don't get the chance to find out! I highly recommend trying the transdermal version of the Mirtazepine. Works differently. Sometimes if they get the side effect on the pill form the side effect interferes with what you are trying to accomplish..eating. Worth a try.

As far as "the other issues like IBD" the Prednisolone would help that as well as the pancreatitis. The intestines are inflamed so it would help with the inflammation for both. So, it would not be difficult to tell if the Prednisolone was helping if he becomes symptomatic & you see the symptoms become under control. I've never heard of it not working. If he experiences another bad episode, & especially if the other drugs won't work, it would be worth a try. The most dangerous situation is a cat that can't/won't eat. You will know if/when (& again, hopefully not) this occurs & there is a need to try Prednisolone. Thats what makes it easy for me. There is no other option.