Pancreatitis and dosing.. please help!

I posted this also in the main forum, but I do need some advice on dosing.. I am getting super-frustrated with what seems like backsliding.... @Djamila or anyone else who has been through this, could you please help?

My original post is below:
So much has been happening since Spot's pancreatitis diagnosis a few weeks ago. He had a bad week after the initial diagnosis, when he was lethargic and not eating, and clearly not himself. Then he had a good week, where he was almost back to his old self. And now, he's back to being sick again...

Starting last Wednesday, he went off his food again, which resulted in an asymptomatic hypo in the afternoon, which resulted in me reducing his dose. Well, since then I have tried increasing, decreasing, and maintaining his dose, and nothing seems to be working to get his numbers back in control. I still think 1.25u is too high, based on the 129 at +10 on Sunday morning, and then the resulting 400+ readings yesterday afternoon. I dropped his PM shot to 1u last night, which still seemed to lead to 300+ readings this morning. I briefly considered reducing to 0.75u this morning, but then chickened out and ended up going back to the 1.25u that worked before. Was that a mistake? These high numbers in my mind are either caused by a long bounce cycle, or him being ill.. if it's a bounce, I need to reduce; if its because of him being ill, I should probably increase.. I don't know what to do.. I just know I HATE all these high numbers!!

In the meantime, he's been having diarrhea and vomiting since Friday. Saturday morning at 3am, he had such a violent BM that it woke me up from a dead sleep... emergency litter box changes in the middle of the night are no fun at all. The only thing he has going for him right now is that he IS eating.. even if he's being picky about it, I'm not having to force feed! I have him on Cerenia, Pepcid & cyproheptadine and giving him fluids every day. Today I took him into the vet for another specFPL and to get some anti-diarrhea meds.

I am reaching my wits end. He just seems so miserable all the time. He's fading before my eyes, and I just don't know what to do anymore .... if anyone has any words of wisdom or encouragement, I could sure use the boost today

 

I'm so sorry to hear that Spot is so sick. Watching over a pancreatitis kitty is the worst. My heart breaks for you.

Sam has been on and off of p-titis flares for most of the past eight months. A bad week, a good couple of weeks, another bad week....just recently he's managed to string a few good weeks together. Not through any magical treatment. He's just been lucky.

As for the insulin, I definitely do not think you should be reducing right now. The low number was from lack of food, not from a reduced insulin need. You have plenty of data to show that he's staying high throughout the cycle and needs more insulin. I would be fairly aggressive with the increases when he's sick. I would move to 1.5u on your next cycle, and then keep going up every 2-3 cycles until he either perks up or stops eating again. Normally you want to wait at least three cycles, but he's sick enough without living in high numbers too. If you start to see better nadirs (lower blues or dark greens) slow down again.

If you look at my spreadsheet, you'll see when Sam's sick because the dose is going up, and when he gets better, the dose starts reducing. I certainly didn't always do it right: I often chickened out when I should have been more aggressive, or reduced too much out of wishful thinking that he was healing faster than he was. But it can give you a general idea of the climb and reductions. He started getting sick in October, and I moved him back to Prozinc 10/23, so just look from then on.

I would really recommend if you're on Facebook that you join the "Cats with Pancreatitis" group. They've been a great source of information and support through the ups and downs. There is also a Yahoo group that is more technical and less warm and fuzzy, but I would argue they've been a stronger source for medical advice.

You didn't mention buprenorphine in your treatment regimen. I would really recommend you get him on some pain meds a.s.a.p. Pancreatitis is quite painful for them and helping manage his pain will help control his numbers a little better as well. It will also help your heart as watching them in pain is terrible.

And why is he on the cyproheptadine? Isn't that an antihistamine?

Again, I'm so sorry you're both dealing with this. The groups that are dedicated to pancreatitis will be really helpful. If you have any trouble finding either of them, let me know.

 

Ah! I just read your post about the bupe. Sam had the shot once too and it was the scariest thing ever. I made the vet put a giant note in his file to never ever ever give him that again. He does just fine on the oral bupe. Much lower dose so he doesn't get the freakish side effects.

 

Thanks for the advice and all the info! This is a lot to take in...
The cyproheptadine is the appetite stimulant. It does seem to work on all but his worst days. As for bupe... I took him in for a 3 day injection when he was first diagnosed and that did not go well. The dose was too high and it made him a weird shell of himself. He sat in front of his food bowl and stared at it for 3 days like he didn’t know what to do with it. He was so out of it I had to coax him to swallow when force feeding. I’m a little nervous about putting him through the injection again. He doesn’t appear now to be in pain. He is laying around a lot but in a sprawlly way, not meat-loafing... and he’s eating on his own so that in itself is better than last time. I will be asking my vet to order some oral bupe for him but she doesn’t use it in her practice anymore so will have to get it just for me ($$$).
Thank you for the advice on dosing. You are absolutely right about him being sick enough without the high numbers... I’ll go back to 1.5u tomorrow and hope he keeps eating!
I will definitely look into the groups you mentioned!

 

I've read so many cats on here that have reacted poorly to that shot. I really wish vets would stop using it. Or at least warn people. Sam didn't sleep for over 30 hours. He just sat and stared and stared. It was awful. I was terrified to even try the oral bupe after that, but it's been fine.

And yes, it is rather pricey at my vet too. I also use CBD when his pain is milder, and then save the bupe for the bad days.

 

Thank you @Djamila - I was hoping for your wisdom on this! Get we’ll Spot!

 

I've been researching the CBD today.. that seems like a really good option. Pretty inexpensive too. Have you seen a noticeable benefit?

 

I've seen benefit in three ways:
1. During p-titis: he's able to relax his body when he takes it which is an indication of less pain.
2. Also with p-titis: it helps increase his appetite
3. At other times: Sam has a boredom/anxiety habit of chewing on his nails. When he's taking CBD, he stops doing it.

I think it's definitely a good tool to have in my kitty tool box.

EDIT: I will say it's not as effective for pain as the bupe. When he's really sick it doesn't quite do enough, but when he's past the worst of the flare it's perfect.

 

The appetite thing is definitely a big draw! Its also good to have an option for days when he's just a little off, instead of using the bupe right out of the gate (which is still scary to me). I've read it can also help with nausea. I think I'm gonna give it a try

 

The CBD tincture I give Sam does have a little THC in it. There is a bit of controversy about that still with some folks saying THC is fine for cats and others recommending caution since there aren't studies to prove that yet. THC is dangerous for dogs. Mine is 50:1 CBD:THC, so it's just a teeny tiny bit, but thought I'd mention it since I don't know if the results I get are connected to that at all.

 

Today is Spot's second full day on CBD oil, and I have to say, so far I'm very happy with the results. I'm trying not to get over-excited, recognizing that he was already on the upswing after his pancreatitis flare, but his appetite is better than it has been since he was diagnosed with diabetes back in November, and he also seems a lot more relaxed. He's a completely different cat than a week ago! I feel like things are looking up

Now I just have to get his BG numbers back under control. Step 1, transition him away from the higher carb food again (definitely made easier by the CBD oil!).....

 

Yay! So great to hear it seems to be helping! What dose and strength do you have him on?

 

I have him on PetReleaf 330, which contains 3.3mg of active CBD per dropper. I've been giving him 2 drops at a time about 5 times per day, which adds up to about one dropper.

 

The CBD oil has done what the all the other meds could never do.. it has given him a consistent appetite! Its pretty amazing.. this is the best he's eaten and for the longest period of time since his FD dx 6 months ago! The past few days he's been eating everything I put in front of him. YAY!!

So I have him off the higher carb food now, and with him eating consistently I think its time to get him back on track with his dosing. I was hoping without the higher carb stuff, I'd be able to drop his dose a bit but aside from the occasional stray low number, he's just been sitting in higher numbers. I was very shocked that the 1.75u yesterday was a pretty flat line all day.. the question is, how much higher am I gonna have to go with his dose to see a good curve again! Fortunately my daughter is out of school for the summer so she can keep an eye on him during the day as we increase. I know I left him in high numbers too long, so I just hope we can get him back on track soon!

 

Hooray for pot-head kitties!

I'm so glad you've found the CBD to be effective!

Some cats don't respond to an increase until the 3rd or 4th cycle, so I would hang on to that 1.75u dose for a couple more cycles and see if anything turns up.

As far as how much Spot will need.....well, a cat needs as much as he needs. Some cats only need half a unit, others need 18 units (or even more!), so you just keep raising and monitoring and when it starts to look good you refine and adjust from there.

I wouldn't worry too much about that long flat day yesterday. You have moved the dose a few times in the past few days, so just wait until he's been at the same dose for a few cycles and then assess the next step.

 

I'm SO glad the CBD is helping!!

 

Wow that is a lot of yellow! Will you be around tomorrow to monitor? If so, I'd go ahead and move to 2u in the morning and then keep an eye on how he does. If you won't be around, wait until the next cycle when you will be and raise it then.

 

Yeah I’ll be around. I was thinking the same thing. He’s getting so little action at this dose. It makes me wonder if the new vial of insulin has gone off already..... I think I’m gonna try giving him a dose of the old one to see if there is any difference before I increase. I’m used to a little bit more of a smile in the numbers

 

It does seem that the insulin is working though because it's holding down the PS numbers in the yellows instead of the pinks. You're just not getting much of a smile. The change in response might also be connected to the fact that he's eating more now and extra calories could keep him a little steadier - so it might not be a bad thing, although of course still too high.

 

89 at +5 today on the insulin from the old vial. Guess I’m buying some more uuuuughhhhh.....

Also YAY!! for the first green in a while!!

 

Interesting. If you bought the current vial recently from your vet maybe they'd replace it free of charge? ProZinc is so expensive.

 

That would be nice! I’ll definitely ask. Fortunately I have enough to last through the holiday weekend in the old vial. Glad I hung on to it!!