hemorrhagic pancreatitis- pain med question

Hi all,
We're freaking out because we haven't been able to get my cat's diarrhea under control. I'm new to the forum- so I don't have an excel sheet yet, but his last BG was 304 and he had trace ketones in urine. Diarrhea has been ongoing for a week and a half. I have tried pumpkin (no effect), 1/4 tsp psyllium husk for 3 days (poo went from liquid to pudding-ish), Imodium (terrible side effects and little impact on the diarrhea), Fortflora, Pet Ultimates Probiotics for Cats, and kaolin/pectin solution. The last 3 things in my list were started yesterday morning, but he had diarrhea again at midnight and 4am.
We had bloodwork done on Fri and his sodium, potassium, and chloride all looked fine. The diarrhea smells bit acidic though.
Not sure what else to try? If the kaolin/pectin is going to work, will I see the results today? I am desperate to get this under control because he hurt his leg on Fri and is limping, which I think is keeping him from drinking as much water while he has the diarrhea- worried about dehydration.
Thanks much!
AJ

 

Metronidazole (Flagyl) get it from your vet. How much pumpkin are you giving? You can keep increasing the pumpkin and give it several times a day until you notice a change. Your cat may well need a little fluid boost too. To help safeguard against dehydration give unflavored Pedialyte instead of water.

 

Thank you! I'll get the Pedialyte. I was doing 1.5 tablespoons pumpkin 2x per day with no effect. If he had pancreatitis, would he still be eating and hungry a lot?

Also, in the past when he's had diarrhea, the only thing that's helped has been Hill's W/D canned food. But now he's on a high protein, low carb diet. Would it be safe to give him a can of W/D and then get BGs before and after, and give him like .25u extra Lantus to handle it if there' s a big increase in BG?

 

Hi AJ,

Keep an extra close eye on his BG if you're adding fibre to the diet - it can have a lowering effect on BG levels and you may need a dose adjustment.

Based on what I've learned in the past year, pancreatitis flares are usually accompanied by reluctance to eat but every cat is different (and my knowledge is limited). If it is something you're concerned about then I'd recommend discussing it with your vet.


Mogs
.

 

The vet can give you Flagyl or Panacur. Probiotics can help -- my vet suggested plain yogurt but I never tried it. I've just bought Jarrow Formulas 15 Billion CFU probiotic pills but they will take a couple of days to kick in (dose is half a capsule).

Sounds like that amount of pumpkin would have helped if it was going to work. Are you still giving psyllium? Seems like that helped a little, so maybe he just needs some more days of it.

Not to alarm you, but pancreatitis or lymphoma can cause diarrhea. I don't know a lot about them but if it were me, I'd call the vet and ask if he/she thinks either of those might be the cause.

Also, I'd go ahead and give the W/D. It's not ideal in terms of carbs, but if there's something else going on (IBD, pancreatitis, etc), it's more important to get those under control. As you said, the dose of insulin can be adjusted if need be.

Good luck and let us know how it goes.

 

Thank you all so much! I will try the suggestions and post an update. You're all so helpful!
I was at the vet on Fri, and based on his labs, the vet didn't think it was likely to be pancreatitis, but I've read a lot about it now and I'm not sure how he drew that conclusion. He didn't run an fPLI or anything. I am kicking myself for not pushing them to run more tests. It's really hard to get my kitty to the vet because it stresses him to the max and he hardly lets anyone touch/examine him. Even with Feliway, herbal sprays, Rescue Remedy, etc. he still freaks out. That's why we tried Xanax a couple weeks ago. He had bad neurological side effects to it, and the day gave him the first pill is the day the diarrhea started. I wondered if it was the Xanax for a while, but it seems like it would have gone away by now if that was it.

 

I don't know whether or not this might be helpful to you but a few months back Saoirse had a minor pancreatitis flare triggered when a specialist put her on a buprenorphine pain relief trial to see whether it would help reduce the inflammation in her pancreas. Saoirse is very med-sensitive. Prior to the start of the trial Saoirse had been fairly perky and in pretty good form. On the first day of the trial, I gave her two of the higher doses of buprenorphine prescribed. I woke the following morning to find I had a very, very poorly cat. Needless to say I stopped administering the bupe. It did take her a while to recover.

I wonder whether other meds might irritate the pancreas? I'd suggest discussing whether the Xanax might have been a trigger of some sort with your vet.

Mogs
.

 

That's a very good question. I will ask but I have a feeling the answer is going to be that they don't know if Xanax could have done that. I can't believe how few answers I have for how many tests we have run!

 

I didn't know that. Thanks for bringing it to our attention.

 

Know the feeling!

 

We've just been through this with Morrigan, SpecklesandMe. She also had blood and mucus. We had her to an ER vet clinic and paid a fortune to find out that was colitis and the food as a cause.

Call your vet and get a script for Metronidazole (Flagyl). Guaranteed to clear it up within 24 hrs. No side effects for Morrigan or my dog...who also had to go onto it.

Did you change foods?
Canned food too high in fats?
Too quick a change of foods?
Went from kibble to canned food?

Make note of the batch number of the foods that you've fed and call the manufacturer.

You're going to need to figure out what caused it and if it's not pancreatitis (I doubt it too) then, it's food related...maybe even a sensitivity to something like chicken???

But, Flagyl (Metrodinazole sp?) works! Pumpkin and psyllium didn't do a thing to help nor, did probiotics like FortiFlora.

 

One thing to be aware of: Flagyl can have a side effect of causing vomiting and loss of appetite in some cats (that happened to my cat Marshmallow after two doses). But it definitely works. It usually takes about 5 days/doses for the cat to be regular again after starting Flagyl.

 

Thanks, Louellen and Granadilla! I only changed the food after the diarrhea started. I just caved in and gave him W/D canned and we are planning to adjust his insulin dose accordingly. He's had two reasonable poos since we gave him W/D last night and this morning. I am trying to figure out how to rehydrate him but can only find Pedialyte that has dextrose (aka glucose). Any ideas?
Thanks again!
AJ

 

Add a tablespoon or two of plain water to the food.

 

The W/D took care of his diarrhea thankfully (4 pretty normal poos and counting!). Phew! We are watching his blood glucose. But I just got a call from the vet. He was on Orbax 2.5 weeks ago for a suspected UTI. There were rods in his urine, but it was not clean capture (I collected it at home). I was hesitant to put him on it to begin with because of the non-sterile collection method, but the vet convinced us to do it.
On this past Fri, I gave them a new urine sample (again collected from home- this time with brand new no-sorb litter and in a new litterbox). There were leukocytes in it; so they sent out a culture and sensitivity. It came back as E. Coli and the vet wants him on a new antibiotic starting today. So, I am hesitating again b/c: 1) we've barely gotten his diarrhea under control and I don't know if the W/D will keep helping if he's on an antibiotic; 2) are we really sure he has an infection when the pee was collected at home? I know I used a new litterbox, but it could still be contamination, esp since he won't let me clean his bum and had been having diarrhea. Do I want to reload him on antibiotics if we're not sure? I don't know the cost-benefit ratio here.
We were hoping to transition him back to his high protein food slowly starting Fri, but if we put him on the antibiotic, I won't feel safe taking him off the W/D til he finishes all the antibiotic.
Not sure what to do... Advice or any other thoughts?
Thanks so much for all your support!
AJ

 

I can only answer what I would do in this situation....and that may or may not be right or possible for your situation but, here's what I might be inclined to do with this.

1) Since you are unsure about the diagnosis and sterile conditions...I might be inclined to take kitty to the vet and have them do the urine sample (needle into the bladder and not painful for kitty really). I believe it's called Cystocentesis (a needle in the bladder to remove urine). It's about as sterile as it goes.

2) I'd likely ask your vet about the GI upset and whether he/she thinks this particular antibiotic will cause it or not. Some don't.

3) I'd keep kitty on the w/d as that is what is clearing up the digestive upset for now and UNTIL you can get word from your vet as to what to do with the antibiotic. Some vets will say to worry less about that than getting the infection cleared up...which will also bring down the numbers once more cleared. A cat who has an infection will see numbers rising *IF* that is indeed the case but, only a sterile sample will yield a proper answer.

Then, once you know for sure what to do, you can proceed with that course. Please don't be afraid to voice your concern to your vet. If they are a good vet (most are), they will answer your questions and give reasons why they are thinking as they are. I drive my poor vet NUTS with questions, apologize and get the "hey...that's what we're here for...ask away...I'd rather have patients who want to know what's going on than those who just ask me 'how much is this gonna cost?'" So, I ASK and ask and ask. LOL

Hope this is something to think on and form your own opinion on?

 

I'm on board with Louellen. I'd take him back to the vet for the urine capture so you can make sure it's a clean capture. Then if it still comes back that he needs antibiotics, discuss the GI situation with your vet. My vet wasn't worried about that when Marshmallow had diarrhea on antibiotics, he was more concerned with getting the infection fixed. And yes, I'd keep him on W/D until his GI situation is settled down. Having an upset stomach will only make him feel worse and further raise his BG, poor kitty.

Let us know what happens. Crossing paws for a quick recovery!

 

Thanks to both granadilla and Louellen for their responses! I was thinking about calling and talking to the vet about it again- so I will do that for sure. I really want to get a cystocentesis but I need to find a vet that does house calls, b/c going to the vet often stresses him out so much that he gets diarrhea all over again.
I have thought a lot about what would have happened if we'd had him since he was a kitten (we got him around age 1) and had just driven him around in the car at a young age to get him used to it. I wonder if that would have worked to reduce travel anxiety later. I have tried Xylkene, Feliway, Xanax, Rescue Remedy, and other calming treats/sprays. He still panics on the way there even though it's literally a 5min drive!

 

You and I are both in the same boat again now SpecklesandMe. Morrigan WAS cleared up from colitis on the Flagyl but, 4 days off of it and it's back again. Just started again tonight. Uggghhh. I am thinking that it may be corn or chicken sensitivity in her from the m/d kibble now. Waiting to talk to the vet about this tomorrow when he's back in again.

 

Oh no! I'm sorry, Louellen! I feel for you and Morrigan. Hope it clears up really soon!

 

Try placing a blanket over his carrier when he's travelling. Sometimes it helps reduce the stress and anxiety.

.

 

I wish that worked. That works like a charm for the ferals I've TNRed in the past, but my kitty has to be an outlier! LOL

 

Systematic desensitization and counter-conditioning may help reduce the stress of vet visits. This is where you take tiny, tiny steps for a week or so at a time and reward him for accomplishing the step with low carb treat, and/or play, and/or toy, and/or praise - things which are mutually exclusive with stress. It is a process, not an event, so you'll have to work at it consistently, every day, to succeed.

IMPORTANT: each step is at least a week, more until you can do it without him getting horribly stressed.

First, leave the carrier out all the time, with a comfy blanket or towel in it, a spritz of Feliway/Comfort Zone or a pinch of catnip, and a favorite toy. Move it around day to day and freshen it every once in a while. When you see him in it, give him a low carb treat and praise him.
After a week or so of this, you're ready to close the door for a moment, then open it again.
Add in picking up and putting down the crate.
Add in taking a few steps between picking up and putting down the crate.
Add more steps until you can get to the car and back.
Add in going into the car and returning inside.
Add in turning on the car, then off, then going back inside.
Add in driving a short distance and returning.
Gradually extend the driving until the time is about the same as the vet trip.
See if your vet will do a practice visit or two, with treats and petting.
Etc.

 

BJM, the process you've outlined above is awesome! Thank you! I just hope we can get him to do it. If I could do it all over again, I would definitely do the above process with him when he was young, before he got set in his ways, but I know there's hope because we've been able to do some clicker training with him somewhat recently.

 

Just be very, very patient and go slowly. Back up a step if necessary or break it into smaller steps if possible.
You can use the clicker in addition to treats.

 

I've had success with calming chews with CJ. She is quite mellow by the time we get to the vet.

 

Cat Ma, can you recommend a particular brand? I've tried some that didn't help but could be that they didn't have the same things in them as the ones you use.

 

One of our vets thinks my kitty does have pancreatitis but the other doesn't. I gave him a tsp of the liquid from his normal Tiki Cat food on Sat night with the W/D and it gave him mild diarrhea again (resolved when I stopped adding anything other than plain water to the W/D). I am considering giving him 1 Marin and 1 Denosyl per wk. Has anyone used these? Is this a bad idea for some reason? Any side effects?
THANK YOU! Thank you! Thank you!

 

Saoirse had some liver abnormalities show up on a scan in the spring, and our vet recommended a SAMe and sylibin supplement. Initially I gave her Samylin (1 tablet a day, Saoirse weighs c. 10lb/4.5kg) but the tablets were very big and I was worried about them going down the wrong way. I switched her to Hepatosyl 50 instead. She gets 1 capsule BID. It's a powder so it's easier to give. I mix it with water flavoured with some spring water from a can of human tuna (palatability can be a problem), but she will eat it at a push mixed with a little of her normal food. SAMe supplements need to be given on an empty stomach. I feed Saoirse mini meals because of her pancreatitis. When her Hepatosyl dose is due, I allow two hours after the previous meal before giving it to her and then I wait an hour before giving her next meal.

Some of Saoirse's liver lab results have improved since starting the supplement in March of this year. The others are stable. Her fasting blood glucose levels showed some improvement, too. (Saoirse has impaired fasting BG.)

SAMe is used as a supplement by some people who have problems with depression. I have noticed that Saoirse purrs a bit after the Hepatosyl sometimes and her mood seems good.


Mogs
.

 

Would it be bad to use SAMe or sylibin supplements if he doesn't have liver abnormalities on his labs? I was reading in the IDEXX pancreatitis treatment guide that they give these supplements as supportive therapy, but is that only when liver issues are present?
I looked up side effects and didn't see anything too serious. What you said about Saoirse purring post-Hepatosyl sounds cute!

 

I don't know, AJ. What age is Speckles? And how are things on the poop front?

 

He is almost 11.
With regard to his poo, if I add any of his old food to the W/D canned, his poo gets to be pudding-y again! Even if it's only a tsp. So, he's just on the W/D for now (which really firms up his poo and stops his diarrhea) and I will try adding a tsp of high protein food to his W/D again at the end of the week to see what happens.

 

With an 11-year-old I'd suggest asking your vet about whether there are any risk factors involved in giving Speckles the Denamarin. (I must confess I'm a bit of a 'when in doubt, leave it out' kinda gal, but that doesn't mean it's a good idea to leave something out sometimes.)

Re the poop, if I were in a similar situation with Saoirse, I would go onto the websites for the different foods I'd tried (including w/d) and collate the nutrition profiles into a single document. With the ingredients of all the problem foods side by side it may be easier to spot suspect ingredients. If you use the w/d ingredients as a reference point, maybe identify ingredients that aren't in the w/d recipe and also see if there are any suspect ingredients in common across all the foods you've tried. It is very hard trying to spot culprits. Eventually I had our vet run some allergy tests from a blood sample for Saoirse. They can identify sensitivities, but there is - apparently - no guarantee of a correlation between a positive test result and the severity of reaction to a particular foodstuff if, indeed, there is any reaction at all.

Prior to commencement of insulin treatment Saoirse had undiagnosed pancreatitis. (I suspect she may have had it for quite some time. ) When she was polyphagic due to the diabetes, the pancreatitis didn't stop her eating anything that wasn't nailed down. In Saoirse's case, it's only when she is nauseated that she becomes reluctant to eat. She's still hungry, though.

As I was typing the first part of this post, it just struck me that pancreatitis may possibly be a factor. Hills w/d is relatively low in fat. A lot of pancreatitis kitties are very, very sensitive to fat. Maybe compare fat content across foods as a starting point, AJ?


Mogs
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Thank you for the detailed response, Mogs! Brilliant idea! I'll compare the food ingredients and fat contents today. I will say that some of the Tiki Cat Gourmet Carnivore foods do seen greasy- maybe that's part of the issue.
"When she was polyphagic due to the diabetes, the pancreatitis didn't stop her eating anything that wasn't nailed down." - This sounds a lot like what I suspected was happening with my kitty...
I will also call the vet about the Denamarin. With our recent history of having new things we try backfire on us, we're better safe than sorry! lol

 

Glad I could give you some ideas, AJ. Food woes are a mare to get to the bottom of. (*sigh*). It may be worth getting a Spec fPL test done to determine

On the liver supplements, the liver deals with fats in the body. I wonder whether Maybe hold the Denamarin in reserve for now, but don't completely rule it out.

Be sure to update us with developments.


Mogs
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@SpecklesandMe Just an update on Morrigan to add to this discussion as I've been busy but, watching this thread still.

Morrigan is on her "taper off dosing" for the Flagyl and solely on the m/d kibble. She's on 1 dose every other day then, she'll begin every 3rd day for 1 dose and see where she goes but, her numbers are WAY up again on solely this m/d kibble. Yet, I was told to NOT up the dose or change foods until we see where she's going with this colitis stuff as even a dose change can "stress" her body and GI system. And NO food changes whatsoever. However, I'm going to have to ask him about w/d now and dose up to it.

@Critter Mom ....I also agree with you that holding off on adding anything more might be wise for both of us. I really like the idea of comparing ingredients. Though my vet swears that a true allergy to ingredients is 1 in 1 million....I'm far from convinced of that through personal experience with myself. I won't get into the phonecall I had with Hills yesterday as I'll go off on a total rant about their lack of ability to answer questions about the food other than a "canned response" from a computer screen. (rolls eyes here) And, don't get me started on their "nutritional counselling" line!!!!!!!!!!! Trust me....I asked....there are NO vet nutrition trained persons manning those phones! They are simply customer service people who have been schooled on Hills jargon. If you ask anything out of their "scripted responses" from a computer screen...they will tell you that they can't answer it. And, when I finally asked if they are "vet nutritionists"....they told me that they weren't. They were simply schooled on Hills and took seminars. I was told "you ARE asking all of the right questions....we just can't answer them". I got to supervisor's supervisors and even they couldn't answer the questions. When I finally asked where all of the so-called "thousands of vets and vet nutritionists are that Hills brags about having on staff"....they answered...."there aren't any...you'll have to seek one out on your own." HA! So much for Hills! There's more to it but, I'd take a day and a half to rant about it. Better I don't go there for your sakes or mine. LOL Besides, I like my computer.

I'm SO with you SpecklesandMe on this with wanting to get Morrigan onto canned foods but, this darned digestive thing is a HUGE issue! I hear your frustration as I've pounded some pretty innocent pillows to shreds over the past several weeks now. I need a new set now.

How are the numbers going on the w/d? Is it the wet or dry version (Morrigan won't look at any prescription wet foods). And, by the way, I really DO believe that "fat content" IS an issue....as it is for me, personally as well.

 

@Louellen - Class 'A' rant! Fair dues to you for getting so far up the chain of command.

When Saoirse went to the specialist hospital earlier this year I mentioned that I was considering the possibility of moving Saoirse to a home-prepared diet if I could not find a commercial low carb food she would be able to tolerate. The specialist told me they had a wonderful centre in America that they consulted on feline nutrition issues and that said centre would be able to provide me with recipes should I wish them to place a referral on Saoirse's behalf. She then informed me the wondrous American centre of excellence was Hill's ... ...

I respectfully declined the referral.


Mogs
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@Louellen, keep us posted on Morrigan's progress as you wean her off the Flagyl. I'm surprised your vet didn't want to increase insulin if her numbers are up. If she stays on the dry M/D and her numbers are up, I would think that would increase her GI upset more than an insulin increase. When Marshmallow was diagnosed with IBD I was told that we needed to find a food she could tolerate well and then adjust insulin accordingly. But every bit of vet advice can be as different as every cat. Fingers crossed for solid poops as you wean off the Flagyl!!

 

Mogs back to you too!

LOL...recipes for home cooked food by Hills, huh?
How many bushels of CORN do you think you would have to shuck for that recipe?!
(You know it's an excellent source of protein, so easily digestible, don't you? And, you can charge an arm and a leg for adding it to your recipe! )

Home cooked...HA...I would gladly stand over the stove for Morrigan. Heck, I'd put on a winter coat, hat, boots, mitts, scarves, long underwear, shovel a pathway to stand in 6' of snow....and BBQ her meals for her in the middle of a blizzard....IF SHE'D EAT IT!!

I'd have respectfully told them where to shove that referral now.

 

granadilla...yeah, I'm sure that once we've settled on a diet for sure (there *may* be changes to be made yet still), our vet WILL up the dosage. If he doesn't...I will!

I'm thinking (translation: HOPING) that he's got some real thinking on this going on right now and that he is doing things very methodically so as not to confuse the situation. At least, that's what he's told me that he's doing.

See, I've been asking him all kinds of questions. I even had him paged while he was on his 4th or 5th vacation for this year (I've lost count) and had him call me FROM his vacation because I was fed up with him being ON YET ANOTHER VACATION! (Yes, I seem to send him on quite a few of them!)

We had a nice chat while he grilled salmon on a BBQ.

What he was explaining to me is that we have to get her GI tract settled down with NO other changes right now so that we can narrow it down to what is causing it.
She's solely on m/d kibble as that is what she will really eat. That's ALL that she's getting...besides water. Even the dosage of insulin is staying the same so as not to "stress her system". He's saying that for right now and another few days as we're tapering off...he wants ZERO changes to anything.
*IF* her system is still reacting poorly...there's going to have to be a discussion about diet changes and what *may* be the cause there...*IF* needed.
THEN, once we've decided on a "regular diet"...stay there and we'll do a curve again as well as another fructosamine level and then, change the dosage to suit the diet.

If I can do it...he would like me to try to get back onto ANOTHER canned food as that is where I was getting the lowest numbers...WITHOUT setting her GI tract off again.
If not...and she's ok...we'll stick to whatever she can and will eat that doesn't upset her GI tract and DOSE to that food.

So, he seems to have method to his thinking and treatment plan. I'm just not as patient as he is but, he's the doc and I'm not schooled enough nor, is anyone here really, to make other decisions. Heck...it's my constant switching things to try to better those numbers that *may* have been culprit to the GI upset! He's scolded me for that one too.

Right now, I'm taking it day by day, testing only as necessary (no stressing her out and no need to do more at this moment) and seeing where this goes. This time...*IF* (knock on wood NOT) there were more upset...either it's the m/d itself causing it...or.....(knock on wood NOT) there's something else going on that needs looking into.
At this point in time, he believes that it's been because of changes in food that has upset her GI tract that hasn't ever settled down fully before I attempted to get her back onto the Purina Pro Plan Kitten wet food. This time, he's making sure that I don't screw up what he's trying so, I'm being a good girl!

Sometimes, I just have to let someone else figure it out for me as I sure as heck have screwed this up! I've listened to far too many sources and tried far too many things.
I have to give him a chance to figure this out.

Will keep everyone updated though. One hour at a time, I guess right now, one day at a time. But, I sure HATE these numbers while we're going through this!!!!

 

Hi Louellen,
Thank you for posting about Morrigan. I wasn't sure I was going to have the energy to write about all this today, but when I saw your post, I knew I should. Sorry, everyone, this is going to be a long one...
On Thurs, I called both our vets to say that it was disturbing to me that after 2 weeks of diarrhea, followed by a week of mushy but formed poo on w/d, the poo still smelled acidic and he still seems to be having GI distress. While he's been on the w/d, we've been testing only as needed to minimize stress, but have up-ed his Lantus dose by .25u per injection, and then again another .25u per injection. So, when he started on the w/d, he was on 1.5u Lantus 2x per day and by the end of the week we were doing 2u two times per day. Each time we up-ed by .25u, we gave it a few days to give him a chance to adjust to the incrementally higher dose and re-test.
On Thurs, about 5 hours after insulin shot/breakfast, we used our Freestyle Lite and got 3 readings from the same blood sample- the first was 52 (we were like no way that's real), the second was 164, and the third was 255. The three tests were done within seconds of each other. We decided to up his dose again starting Fri night so that we would be home to watch him. Thurs night he was acting fine. Trying to jump despite his limp, hanging out with me, etc.
Fri morning at 5am, I woke up because I heard him go to the litter box. When I checked on him, he was trying to pee but then suddenly laid down flat in the box (very weird for him). A little later, I did a urine strip when he peed a tiny amount. It was on the highest level of glucose. At 6:15am when we gave him w/d and 2u Lantus and a B12 shot, but he was already very lethargic and acting exhausted ever since he woke me at 5am.
He was lethargic and weak all day. When I checked his skin, he seemed dehydrated. I kept trying to give him fluids (water mixed with Fortiflora and unflavored Pedialyte), and all week we'd been adding water to his canned w/d to the point where it was like a stew at every meal. I think he was drinking less on his own, but attributed it to the added water and the fact that he's limping (we put out lots of new bowls but he only likes drinking in one room for some reason). And I thought the water added to the canned w/d could compensate for some of that given that his poo looking okay.
Yesterday 3pm, I fed him to try to get more water into him. Then I ran another urine strip (his pees were tiny) and it was again very high for glucose. At that point, I could not keep him awake more than 5min at a time and I couldn't get blood from his ear no matter how much I tried, so we rushed to the vet. His vet's out of town and we saw a new person. I told them to run anything they can on the blood (pancreatitis tests, B12 levels, full liver/kidney panels). His BG on their monitor was like 540! And he was definitely dehydrated. They gave him 100cc of subQ fluids. He seemed to perk up pretty soon after that. I asked if I should up the Lantus and the vet said no. We got home and fed him again (w/d soupy). He was doing okay and then seemed to get sleepy again. So, I started reading about diabetic hyperosmolar syndrome and freaked out. So, we gave him another 50cc of subQ before bedtime. It stressed him TO THE MAX to get the subQ. We were so worried about the stress-benefit ratio but didn't know what else to do.
So, now, he's on 2u Lantis 2x per day still (no increase since vet visit), 2.5u desmopressin 1x per day (for diabetes insipidus), 1 Zenequin per day, 2 Zobaline per day, and probiotics.
I think with his BG peaking so high on top of the dehydration, I am worried about him developing hyperosmolar syndrome if we don't deal with this correctly. And I'm worried he might be anemic. I started adding in a high protein low carb low fat canned food this morning into the w/d. I want to get him off the w/d b/c of the BG#s but I also think his poo will get wetter again if I do. It's a Catch 22. I am so scared. He's our heart and soul. It would kill me if we did the wrong thing. Please let me know what you think. And thank you all so much for your support!

 

the metrodiazole takes a week to help....

but also ask your vet for clay. That also helps....I had to put it in capsules and pill it. Mine didn't want it on her food.

 

We haven't started metronidiazole yet b/c of the Zenequin. I can ask about it once we're done with the Zenequin, but we still have 10 pills to go...

 

Wow, SpecklesandMe....we're both in a bit of a pickle here, aren't we...in differing ways.

I don't have anything that I can add about the meds or other things that you've mentioned as I don't know what they are but, I'm sure that there's others in here who do! (If I start searching and reading up on things....poor Morrigan and poor me....I'll be imagining everything possibly wrong! I even have to meter my time on these boards a bit for when I'm not quite so vulnerable to what "could go wrong" scenarios or I stop sleeping, eating and even leaving the house! LOL)

I do know that when we need to do something for them, the only thing that we can do is to do it...stressing for them or not. We can only try to do what we can, the best way that we can and beyond that...we need to do what we need to do for them.

The Metronidazole does work. That's the good news. The trick, I've learned, is not to take them off of it too quickly. I'm still with held breath on Morrigan's GI tract, trying to wean her off of the Metronidazole and don't know what will happen....and the vet doesn't want to up her dosage just yet either. He prefers to wait to get this GI situation under full control because...he mentioned something about the idea that we don't know how much is food induced with the m/d kibble raising it...or...whether it's the GI tract still somewhat upset or both and where that line lays. So, that may also be YOUR fill-in vet's thinking right now as well????

Right now though, I do know that any food changes that you make...have to be done VERY slowly. At least you're already on canned food so, that's a good thing (something that is a hard trick with Morrigan). I think the most important thing right now is to watch the fat content. Too high a fat content can be bad for the bowels....so, try to do the maths to see which canned foods are lower in fats and higher in fibre??? All of them are going to be higher than the w/d in fat because they have to replace the grain somehow so, the up the fat or fibre content instead. Better a fibre than a fat.

But, right now, I'm thinking....given my situation and vet's opinion...that the way to go is with either Flagyl (Metronidazole) or Tylan/Tylosin...also used for the SAME purpose . It was a toss-up for which one to use on Morrigan. And, if his BMs are not "runny" right now, formed but just mushy, he's likely not getting too dehydrated from losing fluids through the bowels. (The corn is allegedly a good both DIGESTIBLE protein source as well as a fibre source which bulks up the stools). Please excuse me if you've already mentioned but, have you had a stool sample analyzed for parasites/bacteria? Even so...even if it's negative....they still give something like Metronidazole or Tylan/Tylosin....which work. It may be longer termed but, works. I'm wondering if the Tylosin/Tylan is contraindicated with the Zenequin???

Honestly, I think you might be better to keep him going on a single diet that you know is not going to upset his GI tract and dose UP to that food's numbers. If he's even mildly dehydrated...that can also do a number on numbers. Being unwell can raise those numbers...or so, I've read and 4 vets have said.

And, by the way...I know our vets are more than entitled to their days off and holidays and lovely vacations as they work hard BUT...isn't it a pain in the rear when you're really in trouble and have to see a vet who doesn't know us or our pets? About the only thing that I'll say about that is that SOMETIMES...a fresh set of ears and eyes on an issue, *can* render a different perspective and a different angle to come at it with. They'll *sometimes* do more research as well because they want to learn more so, don't stop asking questions...even if you have to call 30 times in a day!

 

Louellen, thank you so much for your kind and thoughtful response. I am a little less panicked now. We were able to do about 100cc subQ fluids this morning and he seems more alert. I really want to try the metronidazole but I guess we're waiting for Mon for his normal vets to be back and some of the lab results to be in (we know he's parasite free). I don't know if it or Tylan are contraindicated with Zenequin, but hopefully not. Originally I was worried about having him on 2 antibiotics at the same time, but perhaps it's worth it given all the issues. I guess we just need to focus on keeping him hydrated and stable til Mon. He is mad at us (hates the subQ) and has been hiding under the bed, but overall he's a forgiving kitty.
Fingers and paws crossed for Morrigan too! Thanks again for your calming and wise words!

 

Dehydration can cause an elevation of blood glucose which probably explains why your vets do not want to increase the insulin until the GI issues that are causing dehydration are dealt with. One problem tends to feed off another so as hard as it is to stick with a plan without seeing a quick response, I think if you find food that alleviates the bowel issues, I'd stick with it with no additions other than water or pedialyte for hydration until you are sure the worst is past. Another marathon to be sure but slow and steady wins the race!

 

Hi AJ. I'm so sorry you're going through this. I know hard it is on both the kitty and the caregiver when our cats aren't doing well. I'm sure Speckles hates the fluids but as you've seen, they help so much. I agree with @Louellen about sticking to the W/D. You've found a food that works for now, so I would stick with it until you talk to your regular vet on Monday. When a kitty has diabetes plus another issue, the school of thought seems to be: treat the other issue and adjust the insulin as needed. Once the other stuff is under control, maybe then he'll be able to tolerate a food switch.

Please try to take a moment for yourself and breathe. Marshmallow was sick earlier this week and I also wasn't feeling well. I ignored the wise advice I received here and didn't take care of myself, which made me worse. I can't help Marshmallow if I'm not doing well myself. So I'll paraphrase the wise words of @Critter Mom and say: please try to take care of yourself as well. Best of luck and keep us posted.

Shane

 

Sulfasalazine...... usually 1/4 tab bid 100 % successful with all mine in two days.

 

Thank you all so much for being the voices of reason. We were going nuts but we managed to do subQ twice yesterday and this morning he seemed less dehydrated (skin test). He was also walking around a little more. So, hopefully (really, really hoping), we're over the worst until we get the lab results tomorrow. THANK YOU all again!

 

We're all hanging in there with you for good results and the ability to speak to the vet as to what your next step is now. Sending good energies!

 

What a rough time for Speckles and you. Keeping fingers and paws crossed for good results tomorrow. Bonnie has a history of diarrhea and vomiting. Flagyl works for her. It's been a combo of diet change, meds and B12 shots and she's doing very well now. The minute she gets into CJ's food, there's a mess everywhere.

I use GNC Relax calming chews for Bonnie and CJ. I also spray their carriers with Pet Rescue Remedy. I believe the ingredients in Pet Naturals calming chews for cats are the same or similar to the GNC chews but I haven't used Pet Naturals yet. Both are found at pet store chains like Petsmart and Petco plus online. If Bonnie and CJ are sick and can't eat the chews, then I give them Licks Zen via syringe. I found that at Petco.

People always comment on how sweet and relax my cats are at the vet. Without the calming remedies, CJ turns into a solid bowling ball and Bonnie shakes constantly. The instructions say to give 1/2 hour prior to a stressful event but I give it at least an hour before.

Keep us posted on Speckles.

 

@SpecklesandMe, how is Speckles?

 

Thank you for asking! A couple hours ago we had a normal color, fairly formed poo (as opposed to yellowish) and it smelled a little less than it has for the last several weeks. He is still a bit dehydrated. We are trying to wean him off the 2x/day subQ and only do it once in the mornings, but if he doesn't start drinking more, we won't be able to yet. I've been adding water/Pedialyte to each meal. I am hoping he's on the up swing now. Fingers & paws crossed!

Edited to add: Thank you for the calming product info! Cannot wait to try them before the next vet visit!

 

Hi AJ,

Very glad to hear that things are improving for Speckles in the litter box department. Saoirse had bad diarrhoea last year during a major pancreatitis flare. I'd never had a cat with diarrhoea before - so scary! It went on for weeks, and I started worrying she'd never ever have a solid poop again. I just wanted my baby to get better so desperately. I'm sure it must have been a relief for you to see better-formed poop yesterday. Fingers and paws crossed that Speckles will start drinking more very soon.




Mogs
.

 

Sounds very familiar! lol
Another poo last night at 3am. (He must think I'm insane, waking up in the middle of the night and running to the LB every time he goes!) It was slightly more yellowish again and smellier than the last two. What a rollercoaster!

 

Thrill-a-minute stuff, this critter parenthood lark ...

Yellowish poop is better than no poop at all.

 

So, true!
In any case, we got the fPLI back, and although he wasn't fasting when they drew the blood, I think it's high enough (>51) to indicate pancreatitis. Mogs, you were right several posts ago on that! So, not sure what the plan is. I am meeting with our regular vet on Fri. I suppose in the meantime I have to keep him on the W/D, although his interest in it is fading very fast and I've been coaxing him more and more to eat. Any additional advice would be much appreciated.

 

I am so sorry to hear about the setback for Speckles. Critter Mom will be very helpful with suggestions.

 

Have you read over our pancreatitis primer?

 

Hi AJ,

Very sorry to hear that the Spec fPL came back positive for pancreatitis. >50 is high but from what I've read here and there the numeric value and symptom severity aren't completely correlated. When Saoirse was at her worst last year her test came back in the high teens. I was wondering when you said Speckles' poop was yellow. The poop discoloration and whiffiness is due to lack of pancreatic enzymes for digestion. Hopefully this will resolve when the right treatments are in place and the colour and consistency of the poops should go back to normal. If not, then consult your vet about pancreatic enzyme supplementation.

If Speckles is finding it harder to eat it that may be down to nausea and/or pain. Here's the nausea symptom checker from Tanya's Site that I found very helpful (for both pancreatitis and CKD). There's a page on pancreatitis at that site, too.

First up, elevate Speckles' food and water dishes so that he doesn't have to bend down to eat. If he'll take some water mixed up with the food that will help with hydration. If not, you need to get vet input on this.

Vetty Bean Checklist for Friday:

- generic ondansetron for nausea (Zofran, the branded version is crazy expensive) - a must-have. (NB: for the UK the Bristol Laboratories generic ondansetron is recommended for cats by experienced caregivers. Try Boots or Morrisons if your vet can't get it from their wholesaler.)

- cyproheptadine for appetite stimulation (small doses can work better (e.g. 1/8 4mg tablet 2-3 times a day for 10lb cat) - larger doses can cause too much sedation and somewhat depressed mood) - also a must-have.

- famotidine or ranitidine for stomach acid (may not be needed but very good to have on hand).

- Course of weekly VITAMIN B 12 injections - once a week for several weeks (check IDEXX pancreatitis treatment guidelines for how many weeks initially and also maintenance) - another must-have.

- buprenorphine for pain relief. (Saoirse does better on small doses - <0.1ml for 10lb cat ad hoc, max 2x per day suited her at height of flare - higher doses disagreed with her in a big way and made her very lethargic, but ECID).

- Flagyl or Stomorgyl 2 for the diarrhoea (antibiotics - both contain metronidazole). Our vet prescribed the Stomorgyl for Saoirse because apparently it's not quite as foul-tasting.

- Pro-Kolin for diarrhoea - kaolin paste with probiotic (not sure what products might be available in the states).

- Nutramed (UK Only) - anti-inflammatory herbal supplement (boswellia, milk thistle, maritime pine bark).

- Liver support - check the IDEXX guidelines on supplementation with Denamarin or similar and discuss with your vet. The liver and pancreas are side by side and inflammation in the latter can irritate the liver also. (I give Saoirse Hepatosyl 50.)

Note: ondansetron and buprenorphine can cause a little constipation.

I can't emphasise strongly enough how valuable it is to keep a stock of ondansetron and cyproheptadine at home from now on so that you can address any reappearance of nausea symptoms quickly.


Food and Water:

- Fluids (preferably through adding a little to each meal), else consult vet about alternative methods.

- Feed small, frequent meals - something highly digestible helps. I fed Saoirse chicken breast gently poached in water, minced finely and served with a 50-50 mix of the poaching broth and water. At the height of her flare last year I fed her 1 tbsp minced chicken with 1 tbsp water and 1 tbsp broth every hour, 24/7. I bought several timed feeders to dispense her meals while I tried to get some rest. Even if appetite improves, keeping to mini meals (not necessarily as frequently as 1 every hour) during the height of a flare puts less strain on the pancreas. Gradually I managed to wean Saoirse onto Liquivite liquid recovery food and that helped keep her hydrated as well as getting the full complement of nutrients she needed. (Not sure which are similar products in the US - maybe ask your vet or members here for suggestions.)

- Slightly warming food, or sprinkling it with crumbled up freeze-dried protein treats helped Saoirse.

- Going forward, any changes to diet should be made cautiously; ideally only one slow change at a time.

Hope some of the above helps or gives you some ideas to try for Speckles. I hope he feels better soon. If there's anything else I might do to help in the meantime, just tag me. Pancreatitis sucks to the high heavens.





Mogs
.

 

Thank you! I am printing out the "Vetty Bean Checklist" to bring with me tomorrow. It's very helpful. Mogs, how long has the longest episode been for Saoirse? I can't believe he's had these issues for about a month already.
Last night at 8pm, he pooed and it looked brown again. He was acting weak and sleepy- so I was really worried and up half the night monitoring him. It was the first time in a long time he didn't poo in the middle of the night and he also peed only once (weird b/c we gave him subQ right before bed). I swear it's like he knows we got the fPLI back... he didn't want to eat this morning, and we had not had that issue before! I've coaxed him into eating and am following the tips above. I stayed home today watching him. I am trying not to stress out so that he doesn't feel my stress but it's super hard not to!
BJM, thanks for the primer. I read it and printed it too. Cat ma, thanks for the support!

 

Hoping that you get the help and meds you need tomorrow. Keeping on sending good and healing vibes!

 

Lethargy is a very common symptom, AJ. I'd like to be able to tell you that I sailed through Saoirse's bad flare last year without a bother but I would be lying through my teeth. I was frantic with worry. Saoirse was frighteningly lethargic at one stage. She was really bad for two months - BUT - that was probably because our vet was a little reticent about prescribing ondansetron for her as he had not used it before. Instead she was on Reglan (metoclopramide) for nausea and it's frell all good for cats because they have frell all of the receptors it targets. (See the IDEXX guidelines for more on this.) From the time I finally secured the ondansetron Rx she progressed in leaps and bounds after that, and she was much improved within a few days. It's a wonderful medicine for nausea.

Brown poop is good. We want to see more of that. It's very helpful to use secondary monitoring during a pancreatitis flare, including time between poops. You'll drive yourself nuts wondering whether or not something else is up otherwise. By keeping a log of time between poops you'll get some idea of Speckles' typical transit time. Monitoring poop characteristics is valuable, too. In particular it can help you identify foods that do and don't agree with Speckles. I did fecal exams of every poop Saoirse produced for many months before I finally found a food she could tolerate.

Sending some get-better-soon scritches for Speckles, and many for you. Flares can be tough, but they do pass. Remind yourself of that when you're worrying. We'll all be here to support you through it. The right meds make all the difference in the world.



Mogs
.

 

I noticed last night that he was breathing harder. It's 2am here and he's breathing even harder now. I will get him to the vet asap in the morning, but usually in the car, on the way, he starts panting. In combination with his current breathing issues, is that dangerous? What I can do? I have an albuterol inhaler that's for people, but I just don't know what to do if he hyperventilates in the car.

 

Is there any way to get him to the ER now? That heavy breathing isn't a good sign.
Perhaps you should start a new thread and add a 911 to the prefix so someone will see your message right away. But I'd just rush him to the ER if you can. That may be the best place for him right now.

 

((AJ))

I second Cat Ma's recommendation to get Speckles to the ER as soon as possible. Phone them before you go for advice about the panting. Be sure to tell them that he pants in the car at the best of times.

If you are travelling with him, maybe partially cover his carrier with a blanket or a large towel. Keep talking to him and make sure he can see you for reassurance.

This is pure conjecture but sometimes when cats are stressed they pant. If Speckles is in pain from the pancreatitis perhaps that might be making him pant?

We're here when you need us.


Mogs
.

 

I've just had a scoot round the web. I found an article on pancreatitis and it states that 74% of cats with severe pancreatitis exhibit rapid breathing as a symptom. (Obviously no guarantee that the pancreatitis is the problem but it is a definite possibility.)

Let us know when you can what's happening. We'll be worrying about you both.

.

 

THANK YOU, Mogs and Cat Ma! Will post a detailed update in a few more hours when we know more.

 

Sending some prayers and your way, AJ. Is Speckles at the vet's?

.

 

Back from the vet. He thinks the breathing thing was related to too much subQ fluid. We're only going to do once a day from now on. He said if he won't eat the w/d, we should give him whatever he wants... better to eat and have diarrhea than not to eat, I guess. We have Cerenia (if it doesn't work, I'm going to ask for Zofran) and an appetite stimulant (will post the name in a bit- can't remember right now). He has ascites. Sent a sample of the fluid to the lab. We are supposed to start Marin. He also got a pain patch (smaller than what would usually be used for a cat his size so that he doesn't get more wobbly, given that he's limping already). He ate a little W/D mixed with Tiki Cat salmon when we got home. I am going to do mini-meals as Mogs suggested b/c he seems to tolerate that better. We are very worried. He's supposed to have an ultrasound on Wed to make sure nothing else is going on. Also, waiting on results from a fecal pcr just in case.
Thanks so much for all your support! Will continue to update...

 

Just reading this now so, hoping all is ok and sending good and healing energies!

ETA: Your post update came as I posted mine.
It sounds feasible that there's too much subQ fluid and that could be an issue that causes heavier breathing.

 

Hi AJ,

Relieved to hear back from you, and that Speckles was cleared to come home after the vet visit. I'm glad the vet did something for pain relief.

Try to make the meals a bit soupy with added water, AJ. I always measured the amount of water with a tablespoon so I could keep track of what was going in. I used to weigh her litter clumps to gauge what was coming out the other end). That's how I managed to keep Saoirse hydrated when I was home nursing her. That said, I wasn't giving her sub-q fluids so you'd need to balance the two.

Keep an eye out for nausea symptoms after the salmon. It can be a trigger for some cats.

Does Speckles like chicken? If he does then skinless chicken breast poached in water then finely minced and served with some of the poaching broth and a little water would make some easily digestible meals for him. Our vet recommended the chicken; it helped me to keep getting some nourishment into Saoirse at the height of her bad flare last year.

Sending more and prayers for Speckles to feel better soon. Try monitoring and feeding him in shifts so that you'll be able to get some bit of rest.



Mogs

 

Glad you got him to the vet quickly. If necessary, force feed. @Critter Mom suggests Liquivite liquid recovery food. I am assuming you are in the States and wonder if something comparable is available. See also the other tips for feeding @Critter Mom suggests. Getting food down is important but if you can avoid diarrhea, even better because diarrhea causes dehydration. It's a tough juggling act but hopefully you will find the right balance to help Speckles on the road to recovery.

What a very rough time for you and Speckeles. Hope you can get some rest today.

 

I think Virbac do one but for the life of me I can't remember the name. (Danged PTSD... )
.

 

Thank you for the idea. I tried it and he wouldn't go for it.

About 1.5hrs after he got his meds (Cerenia & mirtazapine), he ate a can of Fancy Feast Classics Beef. That was 5 hrs ago. I can't get him to touch anything else. I've opened literally 14 cans of different brand/flavors food and even tried 2 kinds of kibble. He's being stubborn. I think part of the problem is that he is still gagging when he tries to eat. I called the vet's office, and the other vet said I can go get Zofran tomorrow. Is the consensus that the Zofran might work better or is stronger? I read that you can use Zofran and Cerenia simultaneously (or alternate) for cats, but I don't know if Zofran is safe with mirtazapine. If anyone knows, please let me know. I'll also be trying to look that up.

Edit: So, he's eaten 1 can FF beef pate and about 3tbs w/d with salmon Tiki today. I am thinking this is not enough?

Also, how does the mirtazapine compare to the cyproheptadine? Should I ask for the cyproheptadine instead?

I'm not sure how to know if he needs a famotidine, but I have some of that on hand. I got some liquid meal replacement stuff. It's Catsure. No one sells Virbac's Rebound near me. I think I can find Clinicare tomorrow. I am planning to force feed before bed if he still won't eat then. The vet said this is "hemorrhagic pancreatitis". His birthday is in 11 days. We are building him a windowbox. It's almost ready, but now I'm so scared he won't get a chance to use it. I'm willing to try anything if anyone has more ideas.

We appreciate all the support and positive thoughts.

 

"I'm not sure how to know if he needs a famotidine"
He's not foaming or hunching over...

 

Oh AJ I'm so sorry to hear what's going on. I had better luck with Zofran (Ondansetron) than Cerenia, so it's worth a shot. The Cerenia made her lethargic and didn't seem to help her nausea as much as Zofran. I also tried Pepcid (famotidine) but it didn't seem to do anything. If it did, I couldn't tell. I also had better luck with Cypro than Mirtazapine. The Mirtazapine made Marshmallow spacey and weird but she's very sensitive to meds, so it could just be her. You could also ask the vet if a shot of Zofran is stronger than the pills. Marshmallow was given a shot a little while ago and it seemed to last longer than the pills but it could have been a coincidence.

I think you can give Pepcid at the same time as either Zofran or Cerenia (but double check with the vet) so it might help him to get both.

I'm not sure if he'll eat this, but here is a recipe for a liver shake that cats apparently like:
http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

If he resists being force fed, ask the vet about a temporary feeding tube. A friend of mine had to get one for her cat for a couple of weeks when the cat had extreme dental work and didn't want to eat.

Sending healing vibes and hugs for you both.
Shane

 

Thanks, Shane! We really appreciate it.
I just read on Tanya's CRF that there is an interaction between ondansetron ↔ mirtazapine and that they shouldn't be used together. So, I need to completely switch him to cypro if I want to start using the ondansetron. I need to figure out how long the "wash out" period is for the mirtazapine. For those of you who have switched from one to the other (if there's any of you out there), how long did you wait in between?

 

Bearing in mind it's the weekend, AJ, I'd ask the vet to give you BOTH cyproheptadine and ondansetron (not least of all because cypro is the treatment to counter serotonin syndrome - see below). You may need to let the mirt dose peter out before giving cypro. Note: cypro and ondansetron seemed to enhance each others' action in Saoirse's case.

NB - Zofran costs an arm and a leg. Generic ondansetron is cheaper.

If your vet doesn't have the meds in stock, ring round local pharmacies to see who has them in stock. They're human meds so your vet should be able to give you a written Rx for them. Saoirse benefitted straight away from the meds but I've read that it can take a little while in some cats for them to become really effective. Ask your vet if you can start the ondans with the Cerenia: might give it more of a chance to kick in.

Cypro is gentler in action. Mirt should only be given once every three days. Cypro can be given at 1/8 4mg tab every 8-12 hours (for a 10lb cat) so it's more controllable. Mirt has a stronger kick to appetite initially but it carries risk of serotonin syndrome (see Wikipedia and peteducation.com for more info). Saoirse turned into a saucer-eyed, ravenous kitty Cujo on mirt. It was not pretty. She only got one dose.

Cerenia can be better for nausea. I believe it can be co-administered with ondansetron but check with your vet. I've not done that with Saoirse. (@tiffmaxee - Elise, if you're around can you advise on this?) Standard dose here for ondans is 1mg BID, but our vet Rx'd Saoirse up to 2mg BID. The larger dose helps when she's more symptomatic. Cerenia may be better for nausea when vomiting is present.

Cypro, ondans and famotidine can be co-administered. Leave a gap between famotidine and the others so that it won't interfere with absorption of other meds (according to my vet's instructions).

I gave famotidine for a few days - didn't look for any cues as to when to give it. (Threw everything I could at the flare.)


Sequence I used: (Saoirse weighs c. 4.5kg)

AM
- Ondansetron 2mg / small meal or broth / wait 30 mins then cypro 1/8 4mg tablet (better to get nausea dampened down first).

Mid-afternoon
- Famotidine (SID).

PM
- early evening - more cypro if appetite stalling.
- later evening: same drill as AM for ondans and cypro.

Micro meals - c 1 tbsp chicken 1 tbsp broth 1 tbsp water every hour round the clock.

NB - as Elise recommended to me, I kept to the small meals even when the appy stimulant had Saoirse looking for more. I had to get timed feeders to dispense one small meal every hour in case I would pass out (I have PTSD - sleeping is very unpredictable).

Eliz recommended Liquivite. She said it worked wonders for her kitties when they were sick. It's like a chicken and liver soup. I was very relieved when Saoirse ate it for me. I cut across quite slowly from the home cooked chicken and broth. Many people here swear by the liver shake.



(Sorry this post is such a mess.)
.

 

Correction to previous post:

Cerenia can be more beneficial if vomiting is a problem alongside nausea.

 

He's not been vomiting and now I am wondering if Cerenia is the right thing for him to be on. He's still gagging when he tries to eat- my sense is that he wants ot eat but is nauseated. I called the vet about the cypro and am going to get the ondans today, but if I'm goiong to use the ondans, I would have to wait for the mirtazapine to clear his system first, which might be til Mon.
I am wondering if it's really so wise to drop the subQ down to once a day. This morning he was dehydrated. We were told to ease up on the frequency of the subQ b/c the ascites is probably what's causing the labored breathing. I've noticed the breathing is a little worse at night and he has a fever. I need to get him through to Mon so that we can get the rest of the labs back and hopefully have more options. We are doing mini-meals through syringe feeding b/c the only thing he touched on his own today was some chickenbroth. I can't find the Clinicare or Rebound liq diets. We're really worried.

 

You can give both Cerenia and ondans at the same time.

 

Hi AJ,

Worrying about how things are going with Speckles. Is he managing to eat a little for you? Did you get the ondansetron? And are you managing to get any bit of rest at all?




Mogs
.

 

Mogs, thank you for asking. That's very kind of you, esp when I know you have your own worries to deal with (so glad Saoirse's lump's not serious).

Stress and anxiety levels are very high for us right now, but we are trying to stay calm for our kitty, which is really hard. We are going for an ultrasound tomorrow and crossing our fingers that nothing crazy will be found. The mirtazapine was driving him nuts- he couldn't sleep- so I am advocating for cypro tomorrow, but that means the fentanyl patch will also have to be replaced. Does anyone know the laws in the US for prescribing injectable buprenorphine for home use?

He is pretty weak but seems a little better wihtout the mirt. It wasn't working anyway- we've been syringe feeding since Fri. I have the ondan already but can't use it safely with the fen patch. So, we really need the buprenorphine shots. I am scared. Please keep us in your thoughts.

 

Mogs, did you use the oral or injectable version? THANKS!

 

Hi AJ,

I have been meaning to give you a very valuable tip about food but my PTSD-addled pate could not hang onto the thought long enough for me to get to the computer. Anyways, here it is now. I'd suggest you avoid feeding anything containing carrageenan like the plague. In general it's a highly questionable ingredient. There is a growing body of research evidence that indicates processed carrageenan can cause injury to the GI tract and is also carcinogenic. (It's used to induce inflammation in experiments to test IBD medicines.) I think it is what triggered Saoirse's flare last year. Recently I gave a new food to my civvie. Lúnasa has an iron constitution but she had a really bad digestive upset after eating it. I checked with the brand owners (Sainsbury's). They emailed me a detailed recipe for the food, and I discovered it contained carrageenan, but it was not listed as an ingredient on the pouch itself.

I suggest starting a new thread on Health asking that question: you'll probably get answers faster.

I gave Saoirse buprenorphine sub-lingually. (Very strict dispensing restrictions over here.) Also, because I was observing her more closely I noticed that she would hover over a catnip toy after eating. I looked on the internet and learned that catnip is a traditional remedy for digestive upsets and apparently it targets opiate receptors. After this I would encourage her to 'nurse' on a toy filled with good quality nip (Yeoww organic catnip). She would lick the toy and shortly after she seemed to be more comfortable; a lot of the tension seemed to leave her body and she was less inclined to meatloaf. On a regular basis now I watch Saoirse for signs of crouching after she eats. I spend a little time giving her long, soothing strokes after meals. She then comes out of the crouch and purrs. It definitely makes her more comfortable. I am assuming that it helps release endorphins. I don't know whether similar might help Speckles, but it may be worth a try.

I've been prescribed mirtazapine myself. It's a very powerful psychotropic; and is what my doctor brother would prescribe as "a very dirty drug" in that it messes with an awful lot of bodily systems. My whole system went completely haywire on it. I only let Saoirse have it because I was desperate to get her eating and it's all the vet had in stock on a Friday evening. I was shocked and distressed by the effect it had on Saoirse; it really wasn't pretty. Things were much better for her on her small doses of cyproheptadine, which she started the following week.

I have a good idea of how scared you are right now, AJ, because I was in bits when Saoirse was bad last year and other members have shared their pancreatitis worries here in the past. Bodily Saoirse was in tatters - losing weight and shedding like there was no tomorrow - and she was absolutely poleaxed at the height of her severe flare last year. At one stage she was so ill that I was petrified I might lose her. I managed to keep food going into her and that allowed time for the meds to kick in and do their stuff. Initially progress was very slow - at some stages I feared she might never recover - but I think that was because she was initially prescribed Reglan (metoclopramide) for nausea and it was of limited benefit (and which I discovered with hindsight when reviewing her secondary monitoring notes was dehydrating her). The B12 injections gave her a bit of a boost and the highly-digestible Liquivite recovery food did a lot to nourish her (coat and body condition improved enormously - our vet was stunned at her progress).

Saoirse was really bad for about three weeks (felt like a lot longer) but it took about two months for the major nausea to disappear (ondansetron 2mg BID, 10lb cat). It was the introduction of ondansetron for the nausea that really helped her the most.

At the height of the flare Saoirse was extremely depressed, had no energy and spent day after day lethargically flopped on the floor. Six weeks later, when she had mostly recovered, she looked pretty much like this:



It was harrowing to go through for both of us. It was beyond worthwhile. I hope that in sharing a little of Saoirse's story it may help you to know what's possible even when our little ones get very poorly, and that recovery is possible. Frankly I've been astounded many times since I joined this community to hear stories of the astonishing resilience and capacity for recovery that cats possess.

I am wishing very hard that Speckles will be feeling a lot better soon. I will keep you all in my thoughts and prayers. If you need me, just tag me.





Mogs
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Timing!

 

Addendum: the Liquivite worked a minor miracle for Saoirse.

 

Oh Mogs, you are ALWAYS so kind and helpful! Reading Saoirse's story gave me some more hope. The vet was somewhat negative on Friday and it really got me nervous. (He didn't really give a detailed prognosis, but the ascites is worrisome to him.) I don't think I can get Liquivite here. I will definitely keep trying to locate something similar.

And thank you so much for suggesting starting another thread about the pain med! You really go above and beyond. Thank you so, so much!!!!

 

Hi AJ,

How are you all doing over there today? Keeping ye in my thoughts.


Mogs
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Hi Mogs, thanks again for being so attentive to us!
We had a rough morning. Two of the vets at the clinic were pessimistic about his prognosis given how much fluid was in his abdomen. They drained it, and sent it out for cytology again (it was negative for cancer when they sent it out on Fri- this is a bigger volume of fluid). The ultrasound showed an inflamed pancreas and some "bright spots" on the abdominal lining, which could be due to severe pancreatitis, or something worse. I was feeling horrible, but need to keep calm until the tests come back again (tomorrow or Wed).

I do now have both cypro and ondans. How long does cypro usually take to make kitties hungry? Does it work on the first dose or does it take effect over multiple days? We are still syringe feeding and really want him to start eating soon!

I was told that even if the results do show just pancreatitis, that I need to think about his quality of life. The vet said that we would need to see improvement over the next week. I am hopeful that the new meds, along with the pancreatic enzymes we got to put in his food, will improve things. Please continue to keep us in your thoughts and prayers. I am worried but need to hope for the best.

 

Hi AJ. I'm glad to hear you have the meds on hand. Cypro worked on the first dose when I used it. I'm sorry to hear things are still so rough but hopefully now that you're armed with more meds and enzymes, he'll pull through. Keep hoping for the best. Sending healing light, hope, love and hugs.
Shane

 

Thanks, Shane! That means a lot to me. And I hope Marshmallow is feeling better.
I feel like most people around me, including the vets, are starting to think I'm crazy for trying so hard to get him better. Yet, I think most people on here have had emergencies over the years that their cats bounce back from.
This forum seems to be only place where people truly understand. This is so incredibly hard, but I have to hope that the tests come back okay and that we can beat the pancreatitis. I don't know yet if the cypro is helping b/c we syringe fed him after giving him a dose since we were behind sched on feedings today. Hoping it works for tomorrow's breakfast!

 

Also, does it take like an hour or less than that? Not sure how soon afterwards to offer him food...

 

The Cypro took less than an hour. Maybe even less than half an hour.

Thank you for asking about Marshmallow when you're dealing with so much yourself. She is still sick but I have another vet appointment tomorrow.

Please keep hoping for the best. If you need to make a hard decision, you'll know. In the meantime, keep remembering to breathe and you'll see what tomorrow brings. Big hugs. We're all on this site because we're all crazy cat lovers and our kitties mean the world to us. We get it. Keep us posted.

Shane

 

This is interesting. Ollie had a visit to the ER a few weeks ago and the vet there gave him a hefty injection of bupre for his legs. Bad idea! He didn't sleep for days and it just made the situation so much worse. That was not necessary for him as I don't think he was experiencing pain, just weakness, which increased with the shot.

 

This sounds like the reaction we got on the mirtazapine!