Prednisone and Pancreatitis; Possible Cancer Dx?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by cornad, Dec 3, 2010.

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  1. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    Hello All,

    I have a question concerning steroids, more specifically, prednisone it's effect on pancreatitis. Spence recently went to the vet because he stopped eating and seemed very weak. He has had pancreatitis in the past and I had a gut feeling it was back again. But upon his examination the vet found something that possibly felt like a "mass" in his belly. It can indicate cancer and possibly be the cause of his lack of eating. I asked what the treatment for cancer would be, she suggested palliative because we all agreed Spence is not in good shape for chemo. The palliative option given was Prednisone/steriods but I was told if Spence indeed has pancreatitis that the steroids can be quite dangerous. I asked for a ipL pancreatitis test and it came back positive. I cannot afford the ultrasound at the moment to see if the mass is truly cancer so I decided to treat it as it is cancer with steroids. I felt that it could help him gain weight and possibly eat again.

    I asked around here and received a response that steroids can be used with cats with chronic pancreatitis. I did some searching on google and found some information but I wanted to know if anyone is using steroids to control pancreatitis? I wonder if steroids would be dangerous for Spence since he has pancreatitis? I think I might do a trial run but I'm unsure.

    Any thoughts?

    Thank you.
     
  2. Cheryl and Winnie

    Cheryl and Winnie Well-Known Member

    Joined:
    Dec 28, 2009
    steroids are actually considered to be a front line treatment for p-titis. The pancreas is inflamed and steroids are potent anti inflammatory drugs.
    There is, as you said, no way to tell for sure that the mass that is felt is cancer. Severe IBD can also cause tumors. There is a shared duct bwt the pancreas, the small bowel and the liver. Often times, disease processes of these organs can go together.
    It is important to treat p-titis flares aggressively. and obviously, w/ possible cancer, the degree of intervention is individual.

    I have experience steroids w/ 2 different p-titis kitties. They both also had cancer at different times as well.
    I am a big advocate of using the steroids for p-titis, as it helped my kitties .

    I recently wrote up some information for someone else who was dealing w/ a similar situation,I'll try to add some clarifications for your specific situation-- and it addresses the importance of a multi faceted approach to treating p-titis. and well as further thoughts on steroid use. I hope it helps
    __

    Most cats w/ p-titis flare experience a degree of nausea-- which could explain the inappetence. Although
    pepcid can help in mild cases, it often isn't enough for nausea of p-titis.
    I had great luck w/ ondansetron for kitties w/ ptitis and lymphoma. it is very inexpensive prescription med. it comes in either pill or injection. I had easy pillers, so I went that route. The *big* p-titis vets ( zoran,marks, scherk) all recommend its use. If your vet is unfamiliar, i would be happy to post the dosing ranges for you .
    If there is vomiting -- then cerenia shots can really help. They can only be used so many days in a row though.
    and to note, they can be used along w/ the ondansetron. ( and yes you can give the pepcid with both of them. )

    If your kitty is not eating, appetite stimulants are often used.
    mirtazapine is a very effective medication and only has to be dosed every 3 days.
    http://www.veterinarypartner.com/Content.plx?P=A&A=2552

    another commonly used med is cyproheptadine.
    http://www.marvistavet.com/html/body_cy ... adine.html

    note: appy stims will not work if your cat is nauseous.

    There are also various ways to entice your kitty to eat. and that sounds like it is a problem ( although certainly the pred should help-- and getting rid of nausea and pain and appy stims :) more tools the better !
    If you scroll down on the following link's thread you will see a post of suggestions for appy enticements:
    viewtopic.php?f=28&t=26965

    Pain control for p-titis is extremely important. buprenorphine is a med that is commonly used for kitties with this problem and is very effective. If your cat has p-titis it is generally assumed to be in pain. Sometimes the only way to know if treating pain will be effective is by trying. Please talk to your vet about this.
    You can refer him or her to this by margie scherk, dvm:
    Feline Pancreatitis: Underdiagnosed and Overlooked
    Margie Scherk, DVM, DABVP (Feline)

    Analgesia is of critical importance in the comfort of the patient, but also in the progression of the disease/inflammation through the negative physiological effects of pain. Pain causes disease and prevents healing. Even if obvious abdominal pain isn't present, use a "test dose" of 0.1-0.2-mg/kg oxymorphone IV to see if the patient improves over the approximately 6 hour effective period. If that is the case, then constant rate infusion of a narcotic may be considered or a transdermal fentanyl patch (DuragesicTM) for continuous relief. TorbugesicTM is not as effective for visceral pain as the opioid agonists are.

    in other words, buprenex or fentanyl patches are best options for home care.




    I would highly recommend B12 injections. they can be given in the fluid port or separately.
    again very cheap. big bottle I pd only 5 bucks.
    here is link from texas on that for GI disorders. The Lymphoma, IBD and p-titis vets all recommend.
    http://vetmed.tamu.edu/gilab/research/c ... nformation
    If any anemia is also present, I would also use a multi B vit injectable ( these sting so best w/ the subQs)
    also inexpensive. There is not enough B12 in them for GI therapy. You don't have to worry about giving too much B12. Multi B's can also perk the appy.

    denosyl is a powerful antiox and can help the p-titis and GI issues as well as be a prophylactic for a kitty who is in danger of HL from not eating. If the liver looks like it is an issue, then I would use the denamarin. Try to dose this as far apart from pepcid as you can. It has a thick coating and needs some acid for the thick outer coating to dissolve in the gut. We had a few whole pills show up in the LB. The folks at nutrimax suggested smashing the pill and giving immediately. we would lose a little potency, but enough and better than coming out whole ! just something to make sure you look for in the LB if you use denosyl or denamarin.

    prozyme is a veg. based prebiotic and helps to break down food and ease digestion. i recommend that too.
    and if there is diarrhea ( and with gi issues, some probiotic like culturelle or fortiflora can be of help )

    The thing w/p-titis flare, is it really needs to have all the *guns* thrown at it to knock it down. It sounds like you are already doing a lot. p

    As for the possible cancer/lymphoma. There is really no way to determine if it is IBD or L w/o a full thickness biopsy and immunohistochemical testing done on the biopsy. that means opening up .
    Severe IBD can mimic L to the point of it causing tumors( but they are benign) Steroids can skew any biopsy tests.
    This is an expensive and obviously physiologically stressful on the cat. With the p-titis that may not be the best. And of course, cost must be a consideration.
    Most will treat in situations like this as if it were small cell lymphoma.( and since your vet seems to be aon board w/ at least doing the steroid , hopefully that is not an issue for you, as it can be for others) That usually means pred and leukeran. Adding leukeran depends on other kitty health issues, and is not w/o risks. It is something to talk to your vet about. And also to decide how aggressive you wish to treat.

    Also to note: It seems that I assumed if it was cancer in abd. region it was lymphoma. And that may not be the case for your cat. It was what I had written up for the other person ;-) But thought it still might be of help to you . ( It is also one of the most common form of cancer in that region, sad to say)

    Sub Q Fluids are a key component in treating p-titis flares. (s. Marks, dvm has it on top of his list, as does scherk who states : "Therapy for pancreatitis is determined by the type of pancreatitis. Fluid therapy and pain relief are the cornerstones in supportive care. Sustain blood and plasma volume, correct acid-base and electrolyte disorders."

    IF your kitty continues to decline,from what you/your vet suspect is cancer, I would consider how much pred is being given.and if it is a low dose and not showing signs of being effective ( cat feeling better, eating, etc...) then I would ask about increasing dose. With FD, you may have to increase insulin, but prioritizing illness is important. The *usual* starting dose for pred w/ IBD/p-titis is 5mg BID. It's late , i have the links if you want just ask ! :) The other option , is a switch to dexamethaxsone. It is harder on FD, but for the possible lymphoma factor , often will work , when pred does not. I have personal experience with that x2kitties. and if a switch is made, I highly advise using a loading dose of dex to really knock things back. ( I used oral)
    ----

    Hope your kitty perks up and feels better soon ( and that it turns out NOT to be cancer)
    If you have any questions please ask, and myself or other board members would be happy to do our best to answer them. If you would like further references to the information I wrote above -- i did try to include some ;-) -- I would be happy to share that as well.

    Please keep us posted !

    ps. is very late/early? :coffee: :coffee: so please, if anything needs clarified please ask !
     
  3. tuckers mom

    tuckers mom Well-Known Member

    Joined:
    Dec 28, 2009
    I can't add to what Cheryl wrote, all I can do is tell you that Tucker has confirmed Pancreatitis, has had it since adoption in '05. He started taking pred in March 2010 for a brain tumor that was causing him to walk in circles.

    Since the pred, his CP flares are rare. We started the pred to help slow or reverse the brain tumor, but I'm thrilled with how much better Tucker feels overall. He's an 18+yr old kitty who, with or without steroids, will probably be on insulin for life, he's just celebrated 5 yrs since his FD diagnosis.
     
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