MIshka - Diabetic with CKD and now pancreatitis likely - advice?

OK -- it's been awhile since I've been online and my spreadsheet isn't up to date. Earlier this summer Mishka's BG started trending a little higher and with so much else going on personally I haven't been good at testing except AMPS and PMPS. We've been struggling with keeping Mishka eating, so did some additional bloodwork, etc. and vet now thinks he has pancreatitis. Lab work results pending. It's been horrible trying to keep him eat and trying to figure out how much insulin to give. I've bought just about all the food PetSmart and Chewy has...LOL. One day he'll eat one kind of food, the next day, wants nothing to do with it. Been trying to keep it kidney friendly and also low carb, but some days, I just have to give him what he will eat. So....guess I'm just reaching out for some general advice on pancreatitis. He's taking cerenia and tonight was also first dose of Zofran. Vet says Mishka doesn't seem to be in pain when abdomen palpitated. Also vet said that his standard treatment would be with steroids --- but steroids will effect his BG, right? Negative ketones Friday. Trying to test tonight. Thanks in advance for any suggestions. Will post bloodwork as I get results. Last fructosomine was 250 (Oct 10th). Vet even suggested one shot of insulin a day (which I probably wasn't going to do...LOL).
Debbie​

 

Hi Debbie - I'm sorry to hear about this. Murphy has chronic pancreatitis and has eating habits as you describe with Mishka - he's been good for awhile now (knock on wood) but episodes appear out of nowhere. Cerenia has been a godsend for him - he gets 4 mg daily except increase to 8 mg when he has a flare. Has he had an ultrasound? The standard Rx for pancreatitis is cerenia, ondansetron (for nausea) an appetite stimulant when necessary (I use cyproheptadine), pain control, and fluids if necessary. Ondansetron is a human drug developed to control nausea for patients on chemotherapy. It is highly effective and should definitely be given during pancreatitis. Murphy has only had to have steroids once for his last episode that lasted about 6 weeks - budesonide - it doesn't absorb well; its actions are mainly confined to the gut and supposedly does not affect bs so much - but it did for Murphy. I would continue cerenia (what dose are you giving?) push the zolfran (can give up to tid) and add an appetite stimulant. watch closely for signs of any pain - pancreatitis is very painful. Also, Murphy won't touch any wet food during his bouts with pancreatitis, so I give him Wysong's Epigen90 kibble which is starch free - I also add digestive enzymes to all his food all the time- by adding these, supposedly they decrease the work on the pancreas. And small, frequent feedings vs larger meals.
there's good information about pancreatitis at ibdkitties.net

 

Zofran is what I used for Max who had chronic pancreatitis. It looks like pain medication has not been given. Read the articles on pancreatitis. Here’s a good one.

http://cms2.netnews.cz/files/attach...Treating-and-Managing-Feline-Pancreatitis.pdf

Enzymes usually aren’t needed unless he has EPI and may be why he won’t eat wet food although when still nauseous dry is often what they are more likely to eat.

 

I was talking about digestive enzymes - (plant derived lipase, cellulase and protease) - these are sold at pet food stores - not pancreatic enzymes (for EPI) which are very different and strictly prescription from a vet. The digestive enzymes are supposed to aid in digestion and decrease the work load of the pancreas. I really believe they have helped Murphy plus they help prevent hairballs. Vets are starting to recommend them. I use Naturvet but there are many others. Ibdkitties.net discusses pancreatitis RX and includes digestive enzymes. IBDkitties.net also have a very active and helpful facebook page.

 

@Carol & Murphy Thanks for explaining.

 

For info, Zofran is one trade name for ondansetron. Generic ondansetron is much less expensive than real Zofran

 

Thanks for the info Carol. I will certainly continue both the Zofran and Cerenia. I'll be scheduling the ultrasound soon. Still waiting on all the lab results. Vet says Mishka no in pain because upon palpitation of abdomen he doesn't show signs of pain. However, I see what I think are signs -- such as his tail twitch when I comb him -- which he normally loves!!! Well, off to open I don't know how many cans of food to see if he'll eat

 

He’s gotta eat.

 

He ate a little . Gave .05 of insulin and hoping he'll eat some more later. What's the dosage of Zofran you are giving your kitty? Mishka is 13 lbs and vet prescribed 4 mg 2x day.

 

Murphy is about 12 lbs and he gets 1/4 of a 4 mg pill (or 1 mg) 2-3 times a day
I up it to 2 mg 2 x a day if he is bad. maybe others here can chime in on what dose they give but I think your dose is quite high - I would definitely ask your vet to prescribe an appetite stimulant - check out the ibdkitties.net site and ask again about pain management

 

Thanks again Carol. I skipped the Zofran tonight because now I'm worried about the dose. Last night was his first night on Zofran and I did cut the pill in half (so 1/2 of 4 mg pill). This morning, same dose. Didn't seem to make a difference and to tell you the truth, I'm not even sure now if Mishka is nauseas. He has never really vomited, just smelling the food and walking away or taking a few bites then refusing to eat -- which I interpreted as being nauseas. I think he may be in pain though, despite what vet said. He used to love being combed on his belly, now I've noticed that he twitches his tail when I comb his belly. I'll check out the ibdkitties.net site again. Thank you so much.

 

I know.

 

He's gotta eat, Debbie. I need to give Murphy a little kibble during these bouts - it's all he'll eat. What about some boiled chicken or a bit of liver?http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

 

thanks Carol....he did eat about 1/2 3-oz can of Fancy Feast and then some freeze dried chicken treats and some FF salmon with the high carb gravy rinsed off. He'll hopefully nibble throughout the night (he usually does). No purrs tonight...thinking that he may have some pain. So gonna talk to the vet about pain meds tomorrow. What pain meds do you give? I joined the IBDkitty group and am looking thru their posts. He doesn't like chicken at all. Believe me, I have tried just about everything. He always was a finicky eater. Haven't tried liver though, so that's a good idea. Will probably put him back on appetite stimulant (Entyce). Thanks for the advice.

 

Oh good, he ate Murphy gets buprenorphine for pain
here's another really good reference on pancreatitis

 

hi - I hope you're still checking this page and I hope your kitties are doing okay. I have a question about the entyce, it doesn't seem to appear much on this forum so I'm appealing to anyone who has tried it for their cat. I just gave my guy his first dose and he immediately started salivating excessively and now I just seems generally even more miserable than he was before. I am worried that it was the wrong thing to give him and I'm afraid to give it to him again. Just hoping you might have some helpful information about the drug. And I guess we'll see how he feels a little later.

 

I would write a new post on the general health forum with a ? And title “entyce side effects”or something like that