Recurring pancreatitis...at wit's (and budgets)end!!

Discussion in 'Feline Health - (The Main Forum)' started by Deb D., Dec 30, 2017.

  1. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    My cat Maggie is about 10 years old and diabetic. At the time she was diagnosed she also had a pancreatitis attack for the first time and was in the hospital, touch and go but made it and recovered. Now 6months later...last week she started acting picky about food and a little lethargic...all of a sudden went downhill fast and is now in hospital again after not eating or drinking for 2days, diagnosed again with pancreatitis. I spent over $1000 last time that I am still paying and so far after the last 2days another $700 and counting. I am giving her one more night and if she doesn't improve will have to put her down. If she does improve and can come home i am scared that this is going to happen again and I just can't afford it. Is there any course of action i can take in the beginning stages of an attack that can prevent her ending up in hospital? What dietary changes may prevent this in the future? Her current diet is 1/2 can fancy feast late twice a day plus a small amount of Instinct grain free dry food. She gets 2 units of insulin twice a day...her sugar was found to be high at vet. Any advice would be appreciated. Is it worth trying to save her or an i drawing out an impossible situation.
    Thank you.
     
  2. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    Oh my! How heartbreaking...

    Here's a lot of good info about pancreatitis: A Primer On Pancreatitis

    To answer your question briefly, pancreatitis is managed symptomatically, and the main weapons to have in your arsenal are 1) pain meds, 2) anti-nausea meds, 3) appetite stimulants, and 4) sub-cutaneous fluids. B12 shots can also be helpful. If your vet can prescribe you a stockpile of some meds that seem to help Maggie, you could possibly have them on-hand to use at the first signs of a pancreatitis flare to keep it from getting to the hospitalization stage. There's no way to know in advance how effective the treatments might be for any particular cat, but there is at least hope-- many caregivers here have experience in dealing with pancreatitis flares, and most of the time they don't require hospitalization (again, it also somewhat depends on the cat).

    For everyday strategies, many have found that it seems to help to give many small meals throughout the day rather than a couple of big meals. A lot of us use timed feeders (freezing chunks of wet food for the later meals) to accomplish this.

    I hope this helps somewhat. A couple of questions for you:

    -what insulin are you using?
    -did the vets at the hospital mention anything about ketones?
    -do you know the names of any meds they are currently giving her?

    Hoping for a good outcome for Maggie!
     
    Critter Mom likes this.
  3. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thank you for the info! Good news..vet just called and she started eating small amounts and fever is gone. I asked him same question as above and he said we can try getting her on antibiotic at first signs of an attack, as well as those other supportive meds. They didn't say anything about me doing sub q fluids at home...how does that work? Is it difficult or painful for them?
    She is in 2 units of Lantus twice a day. Right now also Cerenia, an appetite stimulant, a pain med and had an antibiotic shot of coven is plus will be in zeniquin, although I don't know i will get pills down her throat.
     
  4. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    Hmm, the antibiotic is odd-- pancreatitis isn't a bacterial infection, it's an inflammatory condition. Unless the vet thinks there's something else going on that triggered the flare? Sometimes flares can be triggered by stress, anything that stresses the system.

    Here's a video on giving sub-Q fluids: How to Give Subcutaneous Fluids (Video) (warning: if I remember correctly, the set-up in this video is somewhat elaborate-- most folks get by with just hanging the fluids bag on a coat hanger or whatever). It's not painful, most cats do great with it as long as they aren't super-squirmy. Fluids can really make a cat that isn't eating/drinking and is thus somewhat dehydrated feel better, although I would say that this kind of treatment is definitely secondary to the pain meds and anti-nausea meds when dealing with a pancreatitis flare-- those are the big guns.

    So happy to hear that she's starting to improve!!!! Go Maggie!!!
     
    Deb D. and Noah & me (GA) like this.
  5. Noah & me (GA)

    Noah & me (GA) Well-Known Member

    Joined:
    Dec 3, 2016
    Don't get over whelmed at the thought of giving fluids at home, it's completely do-able. Another member has done chemo at home. Good work Maggie.
     
    Deb D. and Nan & Amber like this.
  6. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    When my cat had pancratitis we had to pay for the diagnostic test but we treated at home. We did daily sub q's for about two weeks, cerenia for nausea for a few days until he was eating again, and a week of bupe for pain.
     
  7. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    *** WARNING: VERY LONG POST ALERT ***

    (((Deb)))

    It is possible that, in addition to the acute flares, Maggie may possibly have chronic pancreatitis in which case the symptoms may be 'low grade' for much of the time. Kitties with chronic pancreatitis can be prone to flare-ups where symptoms become more severe. If this is the case then yes, there are many things you can do to manage the condition at home - including things that may reduce the likelihood of Maggie needing hospitalisation (depends on the cat and the severity of the flare, but ***early intervention at home can really help*** and stop a potentially more serious flare in its tracks).

    I found the following key to management of the condition at home (sorry it's so lengthy, but I hope it will be helpful to you going forward):

    * A close, very collaborative, partnership with the vet. When in doubt, always take your kitty for an examination - especially when signs of discomfort, nausea, poor appetite, or constipation emerge or get worse. If your cat is a veterinary 'frequent flyer' then, between visits to their offices, your vet may be able to help you a lot by telephone (thus saving the stress/cost of an office visit). I always checked in with my vet by phone any time I suspected Saoirse's symptoms were reappearing, plus he had access to her spreadsheets (see below for example).

    * Key Clinical warning signs to watch for include: lethargy (the most common symptom exhibited by cats with pancreatitis); symptoms of nausea/digestive discomfort (see list of nausea symptoms in link below); and change in stool quality. Sometimes a cat with pancreatitis may crouch in a tense 'meatloaf' position - especially after a meal - or it may exhibit uncharacteristic vocalisation. Reduced sociability, withdrawal, or hiding behaviours can also alert you to possible GI system distress. Body temperature is another thing to note, as some pancreatitis kitties may exhibit hypothermia (watch for signs that they may be 'feeling the cold'). Know Thy Cat. :)

    I adapted Saoirse's spreadsheet to help me keep track of my observations plus her food and meds. It helped me spot trends in her clinical signs much more easily. Also it helped me to identify foods/meds that did or didn't help her (and it makes it easier to backtrack to something that was working better after any changes have been introduced. Here's a link:

    Saoirse 2015 Spreadsheet

    Any changes to diet or meds were normally made one at a time, and always slowly.

    * Keep watch on how the cat responds to food - even if no diet change has been made. Sometimes a particular batch of the kitty's regular food may disagree with the cat (as a natural product, 100% control of ingredient mix and quality is impossible). Treatment with anti-nausea meds and a switch to a different batch of the food may help resolve symptoms quickly. Here's a very helpful guide to spotting clinical signs of nausea:

    Nausea and Appetite Problems - Symptoms and Treatments

    * Feeding mini-meals throughout the day (once every 3 hours in Saoirse's case) with a little water added to help keep kitty properly hydrated (very important for pancreatitis kitties. (For info, Saoirse was on Lantus insulin which makes mini-meal feeding quite straightforward. Had she been on an insulin that required a large meal to be fed prior to dose admin (e.g. Caninsulin/Vetsulin), this would have complicated her pancreatitis management.) A timed feeder is an invaluable aid when feeding mini meals. Note: if the flare is particularly severe it may be necessary to assist feed smaller, more frequent feeds during the peak period.

    ETA: Raising food and water bowls a few inches from the ground can make it much more comfortable for a nauseated kitty to eat and drink.

    I found that, through adding a couple of teaspoons of water to each of Saoirse's meals I was able to keep her properly hydrated without the need for subcutaneous fluids at home. (Home sub-q fluid admin does not appear to be as prevalent in the UK as it is on the North American continent.) If Maggie were to need home sub-q treatment there are many experienced caregivers here who can help you with that. Many cats get on just fine with the treatment, and it does them a world of good. (It makes a huge difference to quality of life for CKD kitties, for example.)

    * ALWAYS, ALWAYS, ALWAYS keep a supply of anti-nausea and appetite stimulant meds always available at home so that treatment for any nausea or mild inappetence can begin straight away at the first sign of a problem. It is far easier - and better for the kitty - to keep a queasy cat eating than to get a completely inappetent cat to start eating again. It also reduces the risk of fatty deposits building up in the liver (and increasing risk of development of hepatic lipidosis). Lack of food in a diabetic cat may lead to the cat building up ketones which then creates a risk that the cat could go into DKA.

    I used generic ondansetron (branded version is Zofran - way, way more expensive) for pancreatitis-related nausea management and, occasionally, an appetite stimulant. (Manage the nausea promptly and usually the kitty's appetite will stay OK.) For members in the UK reading this, the Bristol Laboratories ondansetron generic may be less likely to constipate a cat than other generics on the market.

    I used cyproheptadine for appetite stimulation. Saoirse only received mirtazapine once, and the side effects she exhibited weren't at all at all pretty (crazed with hunger; very aggressive; pupils dilated to the size of dinner plates; highly agitated; therapeutic effect petered out long before next dose could be given). That said, many cats get on great with mirtazapine (although they often get very vocal - it's nicknamed 'miaowzapine' for this reason!). I found that cyproheptadine did the job required but it was milder in effect and of shorter duration of action than mirtazapine (can be administered every eight hours if required). I found that cypro gives better control over the level of appetite stimulation provided to a kitty and it has a far more acceptable side effect profile. It's an antihistamine and may cause drowsiness. The idea is to give 'just enough' for the appetite stimulant effect to work. In the home situation it helps to start at a low dose - just a sliver of a tablet - and work upwards: too big a dose can make the cat a bit depressed and it may then become less inclined to eat (counterproductive!). At the right dose there might be a little drowsiness after the dose is administrated but I found that the snoozies wore off after about an hour and the stimulant effect then kicked in. If the low dose is ineffective you can titrate the dose upwards (with guidance from your vet, of course!).

    VET NOTE I: When examining a cat to determine possible cause(s) of nausea/inappetence, I've found that vets don't typically check whether the cat might be constipated so it's advisable to to ask the vet to do so at the start of the physical examination. Knowing your cat's regular stool production will help you to identify if constipation might be an issue and it's really helpful information for your vet, too. It's important to address any constipation/gut motility problems first otherwise regular anti-nausea/appy stimulant meds won't be effective (more on this below).

    VET NOTE II: We've seen here that a significant number of vets will insist that there is no need to prescribe additional anti-nausea medication when they prescribe mirtazapine. For a seriously nauseated cat, any anti-nausea effect that mirtazapine may exert is typically insufficient to help the cat overcome its eating difficulties. (It's certainly typical of what we see here in pancreatitis and DKA cats.) It can sometimes take a bit of persistence with the vet (or sometimes consultation with another vet) in order to secure additional, dedicated anti-nausea treatment. If a cat can't get any food down it is a life-threatening situation so if the cat still shows symptoms of nausea on mirtazapine alone don't delay going back to the vet to secure an Rx for specific anti-nausea meds. If the vet insists that mirtazapine alone has worked for all his other patients be clear and firm that success it's not working for your cat and you want something done about it. (The IDEXX document linked below may be very helpful in supporting your case in such circumstances.)

    MEDICATION SAFETY WARNINGS: In some cats there can be a major adverse reaction to mirtazapine if they are being simultaneously treated with buprenorphine for pain. Mirtazapine can induce serotonin syndrome (check online for symptoms); potentially life-threatening but prompt emergency treatment with cyproheptadine can normalise serotonin levels. Note: Cyproheptadine may be contraindicated in a cat with liver problems. Also, as an antihistamine, cyproheptadine can raise blood pressure so it may be contraindicated in cats with elevated blood pressure levels (e.g. those with renal impairment). Cyproheptadine is contraindicated in cats with glaucoma. More information here.

    * Pain Management: A pancreatitis kitty may experience pain during a flare. Physical examination of the kitty may show abdominal pain BUT also watch out for back pain, too. Back pain may be misdiagnosed as joint pain/arthritis by a vet not very familiar with pancreatitis symptoms (happened to us, but thankfully there's the internet so I knew it was flare-related! ;)) NB: If visiting the vet during the acute stage of a flare it may be beneficial to ask for the first dose of bupe to be given via injection as it gets to work faster. Subsequent doses can be administered orally at home.

    As mentioned above, crouching/withdrawal/hiding behaviours can indicate that pain is present. Pain tends to be worse during a flare. Pain can be managed with buprenorphine - and effective pain control can help a kitty to get back to eating better more quickly. If in doubt, it's a good idea to ask your vet to treat 'as if' pain is present - possibly with a relatively low dose of bupe at first (it can always be titrated upwards if necessary). A feline internal medicine specialist advised me that giving buprenorphine to ensure any occult pain present during a flare is addressed will reduce systemic stress in the cat and this can help reduce inflammation, potentially resolving the flare faster. Reduction in crouching/hiding and improved appetite and sociability can be good signs to watch for to assess the benefit of the analgaesic treatment.

    IMPORTANT NOTE: If a kitty has been on buprenorphine for a while then it may be highly advisable to gradually titrate the dose down before discontinuing treatment. (Cessation of buprenorphine treatment in humans can cause dangerous spikes in blood pressure. I've not seen any research to show similar in cats but based on my own experience I have my suspicions that too-abrupt cessation of bupe treatment caused blood pressure problems in Saoirse which subsequently cost her one of her beautiful eyes ... :( Wouldn't wish that on any cat or person. Our main vet gave me a fair hearing when I proposed this hypothesis, but he couldn't add anything.)

    SAFETY NOTE: Because it's a controlled substance, some vets may be reluctant to prescribe sufficient buprenorphine for home care and may instead prescribe Tramadol for pain relief . NB: in humans there is a MAJOR adverse interaction between Tramadol and ondansetron. I've not found anything in my research to confirm/deny that a similar problem might occur in cats but personally I would not risk treating a cat of mine with these meds simultaneously. (Other members may have different views/experiences.)

    (For UK readers following this thread: Buprenorphine (aka Vetergesic) availability is extremely tightly controlled in the UK. If you do need a supply for home admin ask your vet to dispense a supply of pre-filled syringes (you may need to get repeat Rx's every few days). Keeping brief daily journal notes of dose admin times and response to treatment can be an invaluable evidence base to present to your vet in order to secure repeat Rxs for longer-term pain management if it's needed. (It took a while but my vets (who had access to Saoirse's spreadsheets) were eventually comfortable enough to OK to issue repeat Rxs for prefilled syringes to last 1-2 weeks for ad hoc pain management at home.))

    * Severe Nausea/Inappetence that doesn't respond to meds/pain relief: If the above meds don't get a kitty eating better within a day or two (including situations where you've needed to assist feed to keep getting food into the kitty) it is advisable to go back to the vet quickly and ask about feeding tubes. They make assisted feeding at home much more reliable and less stressful for both cat and caregiver and they can save lives. Feeding tubes also make insulin administration for feline diabetics easier and safer (and help protect the cat from complications like ketosis/DKA). If a feeding tube is indicated it is better not to delay in getting one placed. More information here:

    Feeding Tubes for Cats

    * Regularly monitor stool quality and frequency. Sometimes constipation can make matters worse. Constipation can cause a cat to be nauseated/to vomit, and it can make a kitty very lethargic. (I introduced canned plain pumpkin to Saoirse's diet and this helped to keep her regular and her stools were more yielding and easier to pass.) On occasion I had to treat her with Miralax and, if meds/anaesthetics had affected her gut motility, brief treatment with metoclopramide (see IDEXX link below for more info on this drug) to get things moving again - typically only a couple of doses - followed by a switch back to her regular anti-nausea treatment. Looser, smellier stools than usual can sometimes (though not always) be a an alert that a pancreatitis flare may be imminent, as can a change in colour to orangey brown or tan. If so, closer monitoring of clinical signs is important. More information on feline constipation and overall gut function and health at the following site:

    felineconstipation.org

    * Antibiotics: If diarrhoea is a problem during a flare, the vet may prescribe the antibiotic, Flagyl (metronidazole), which is apparently utterly foul-tasting. (Our vet prescribed Stomorgyl 2 for Saoirse. It contains metronidazole plus A. N. Other antibiotic but apparently it's not as foul-tasting.) Vets may also prescribe other antibiotics during a flare as a precautionary measure to protect against infection. Injected antibiotics may be preferable since tablet forms could potentially make GI upset worse. (Note: Many vets prescribe Convenia and this is unlikely to be of much benefit as it is labelled for use in the treatment of skin infections. See Lisa Pierson DVM's article on Convenia for further info.)

    * Maintenance Diet Choice: On food, I found this to be far and away the toughest challenge when managing Saoirse's chronic pancreatitis. It took months and months of trialling different foods find what she could eat reliably and with minimum to no discomfort at mealtimes. With an otherwise healthy kitty, food changes need to go slowly to avoid triggering GI upsets and I found this to be even harder with chronic pancreatitis in the mix. It's not that Saoirse found the different foods unappealling; she just couldn't tolerate them. :( Sometimes you may find that a kitty readily eats some of the new food but then pancreatitis symptoms get worse after the meal and they won't touch another mouthful of it ever again. Sometimes a bit of anti-nausea support can help with the transition but I learned to follow Saoirse's lead and didn't persist with any food option that caused exacerbation of nausea or postprandial discomfort.

    As mentioned above, a food variety that is normally tolerated well may all of a sudden start causing issues (usually increased nausea). Experience taught me to record food batch numbers in Saoirse's daily journal and that helped me to avoid feeding 'problem batches' thereafter. One thing I found extremely helpful was to set aside a 'squirrel stock' of food pouches from batches that I knew really agreed with Saoirse so that I would have something in the house that she could eat comfortably just in case we hit an 'iffy' batch of her regular food. Also, if regular food is badged as a 'new, improved recipe!' (yeah, right ... :rolleyes:) it's important to check the nutritional analysis for any changes. Indeed, sometimes manufacturers change formulations without highlighting it at all so I started regularly double-checking the nutritional analysis of Saoirse's maintenance food as a matter of course.

    Some pancreatitis kitties are more sensitive to the fat content of food. There's a feline pancreatitis support group on Yahoo and members there may be able to give you more information and support. Here's a link:

    Yahoo Feline Pancreatitis Support Group

    * Anti-inflammatory support: Vitamin B12 is good for all cats with any health issues that give rise to nutrient malabsorption plus it has anti-inflammatory and appetite-enhancing effects. My vets prescribed a herbal anti-inflammatory supplement, Nutramed, for Saoirse. It contains boswellia (used by humans with inflammatory bowel disease), milk thistle (for liver support), and maritime pine bark. Many kitties have pancreatitis as part of triaditis, where inflammation affects the intestines, liver, and pancreas. It might be worth discussing additional liver support with your vet (I gave Saoirse Hepatosyl). Here's another helpful link:

    IBDKitties.net

    I've linked to the page on the importance of vitamin B12 but the whole site is worth reading for any kitties with GI issues.

    Finally, here's another extremely helpful link:

    IDEXX Pancreatitis Treatment Guidelines

    It's a great document - from a very authoritative source - to use during vet consults when seeking to get the most suitable and helpful treatments for pancreatitis kitties.

    Hope some of the above helps. Sorry it's so wordy but it's based on hard-won experience. :oops: Cats can live for many years with well-managed chronic pancreatitis. Most of it can be done at home with prompt administration of the right treatments - plus the co-operation and support of a good vet! :)

    I hope Maggie is feeling a bit better by now and that she'll be fully recovered very soon.


    Mogs



    ETA: Feline pancreatitis may occur secondary to toxoplasmosis, a parasitic infection. When performing a diagnostic work-up it may be advisable to ask the vet to also test for toxoplasma as a precaution (if only to rule it out), especially if pancreatitis is suspected in a younger cat or where there are clinical signs suggestive of a parasitic infection. (Note: There have also been cases reported in the States where liver fluke caused feline pancreatitis.)

    .
     
    Last edited: Jan 9, 2018
  8. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thank you so much for the informative post, Critter Mom. I picked Maggie up from hospital yesterday, I was led to believe she was eating but not eating at all at home and gagging when food placed by her mouth. The Cerenia pill I am giving her is not working and I think the shot worked better. I really hate to drag her back to vet again, especially in the cold, but I think the cerenia shot is necessary and a Vitamin B12 shot might be good too. Will have to wait till tomorrow because of the holiday. Breaks my heart to see her like this. How long do these flares usually last? It seems like it started the beginning stages a week and ahalf ago, with the worst of it starting last Wednesday.
     
  9. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Critter Mom has given you some excellent advice and information. My Tuxie had chronic pancreatitis and for him I found that the cerenia shot worked much better than the pill. Especially if a kitty is nauseous and may vomit, the shot will give relief and you don't have to worry about it being thrown up. With Tuxie I found that some sub q fluids, cernia shot and some buprenorphine ( I used the shot form) would help immensely. If he was still not eating I would syringe some food and water to keep something in his system. Usually within 2-4 days he was back to eating. Your vet can give you a few days worth of cerenia in prefilled syringes so that you don't have to take your Maggie back to the vet.
     
    Critter Mom and Deb D. like this.
  10. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Deb,

    I'm glad you found the info above helpful. (Maybe bookmark it for future reference.)

    I strongly recommend pushing for a prescription for Ondansetron. Cerenia and ondansetron act on different receptors in the body to control nausea. Some members here treat their cats with both meds at the same time. Ask your vet for more info. As Mary Ann observes above, every cat is different (ECID) and it is only through trialling the different medications that you can find out which one suits an individual kitty best. With a supply of both ondansetron and Cerenia at home you can try the ondansetron (may take a few doses to reach full therapeutic effect but you can give it once every 8 hours (dose for 10lb cat: 1-2mg every 8-12 hours, to a maximum of 4mg per day). If it works better, stick with it. If not, you'll still have the Cerenia. Also ask the vet for an appetite stimulant Rx if you don't already have some. (Need to give the anti-nausea med first to allow it to get to work.)

    I think your plan to get the Cerenia injection is sound; it will hopefully exert some effect faster than the tablet. Vitamin B12's a good idea, too. (Make sure to get the full course - see the IDEXX document for more info.)

    Did the vet prescribe any buprenorphine for pain relief? If not, I recommend asking for some of that as well (enough for several days' treatment).

    Oh, how I feel for you both! :bighug: I will never forget the feeling of utter helplessness I experienced during Saoirse's first flare.

    Duration depends on severity of the flare. Saoirse's first one was really bad - it lasted for weeks because I didn't know the right things to do for her and which treatments to ask for at the vets (they prescribed metoclopramide for the nausea and it was next to useless. It was only when Elise (@tiffmaxee - to whom I will be eternally grateful) told me about the right meds to ask for that things started to get better (and the vet needed a bit of nagging about the ondansetron Rx, but persistence won the day). Saoirse was back to eating quite well within 48 hours of starting ondansetron treatment, although I had to resort to feeding her home-cooked chicken and broth for a good while. She had really bad diarrhoea for a-g-e-s! At one stage I feared she may never have a solid bowel motion again but as her appetite picked up and I transitioned her onto a regular cat food the diarrhoea resolved fairly shortly thereafter. The full course of B12 did her an absolute power of good, too.

    Always having a stock of meds for Saoirse at home made a huge difference for subsequent flares: any warning signs and I was able to respond straight away and it would take much less time to resolve symptoms - and I was able to keep Saoirse eating fairly steadily throughout (reducing risk of complications such as hepatic lipidosis/ketosis).

    Sending healing vibes to little Maggie - and a gi-normous :bighug: to her mama.


    Mogs
    .
     
    Last edited: Jan 9, 2018
    Deb D. likes this.
  11. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thank you so much for taking the time with these helpful responses, I am hopeful that she will get better this week.




     
    Critter Mom and Vader723 like this.
  12. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Hi and welcome. My Max had chronic pancreatitis for over six years. It would come and go. It’s rare to run a fever so I’m wondering if there’s an infection as well. Daily nausea medication is essential. A cerenia injection only lasts 24 hours. I always had ondansetron and cerenia in hand. Keep offering small amounts of food but if nauseous she likely won’t eat. Mogs has given you great advice.
     
    Critter Mom and Deb D. like this.
  13. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    How's Maggie doing today? And how are you bearing up, Deb? I know how worrying and exhausting these situations can be.

    :bighug:


    Mogs
    .
     
  14. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Well, I took her in for Cerenia shot and B-12 this morning. When she got home she ate a few bites of food that was it. Vet says we may want to consider feeding tube because its been a good number of days that she isn't eating and don't want to wait too long where she goes downhill and isn't strong enough to be put under. I just don't know, sounds expensive. Really hoping she will eat more today but she doesn't acct like she wants anything.Thanks for asking. I am ok but definitely exhausted and stressed from this ordeal.
     
  15. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    :bighug::bighug::bighug::bighug::bighug::bighug: (((Deb))) :bighug::bighug::bighug::bighug::bighug::bighug:

    No joy on ondansetron, pain relief or appy stimulant at the vets? That's got to be very disheartening for you. :( (Been there ...)

    In the circumstances, I think your vet's advice about the feeding tube is really sound - especially about making sure it's done while Maggie is strong enough. While it's true that ECID, based on my experience it is sooooo hard to get a badly inappetent cat to start eating any way reasonably again (even with all the supportive meds needed) that, if I were in this situation with my kitty, I think I'd follow your vet's advice. The feeding tube will make the process of getting enough nutrition into Maggie much less stressful for both of you and you'll be able to reliably ensure she's getting enough calories and fluids (thus protecting her from the danger of developing fatty liver complications or DKA). It will also make it much more straightforward to give her the insulin she needs - and safely. It should also be a lot less exhausting for you, Deb, and you need to keep yourself well in order to care for your girl. :bighug:

    Keep checking ketones in the meantime. I'm sorry I can't suggest anything more to help you both.

    Will keep the prayers and the positive healing vibes coming for Maggie.


    Mogs
    .
     
    Last edited: Jan 3, 2018
    Deb D. likes this.
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I had an experience with a feeding tube in one of my cats many years ago. It was put in differently than most vets do it today. That aside, it's not as scary as you might think and my kitty at the time accepted the tube feeding without issue. As she gradually became more willing to eat on her own I tube fed less and less until she was eating completely normally herself. It took her about 3 weeks. That time line will vary with the circumstances. :)
     
    Deb D. and Critter Mom like this.
  17. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    Hi Deb - Murphy has chronic pancreatitis and luckily, I've been able to manage his flares at home. I agree with everything in this thread- in my experience, daily cerenia has been the one drug that helps keep the flares at bay. He gets 4 mg daily, except during the flares when I up it to 8 mg (he's about 12 lbs)- the second he doesn't eat, I pop in ondansetron, and if that still doesn't work, I give cyproheptadine. During flares, fluids and pain meds (bupe) are a must. Something else - Murphy develops long lasting food aversions when he gets a flare, and during them, he won't look at any wet food at all - he is only interested in small amounts of kibble. so I keep several different varieties on low (er) carb kibble in the freezer for these occasions. Frequently, after eating a small amount of kibble (1 teaspoon maybe) it can jump start his appetite.
    Pancreatitis flare are VERY scary, especially for a diabetic cat, and Murphy's last one lasted about 6 weeks. But they can be managed at home. We are here to help you, Deb
     
    Deb D., Kris & Teasel and Critter Mom like this.
  18. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thank you!!


     
    Critter Mom likes this.
  19. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thank you! 6 weeks, yikes that is a long time, I really hope Maggie's doesn't last that long.

     
  20. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    Would Maggie tolerate syringe feeding?
    I have syringe feed many of my cats, a few for a year or so.
     
  21. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Unfortunately I don't really think so, I tried it the last time she had this and it just ended up being a huge mess with her spitting it out all over. I live by myself and its very hard to hold a large cat and get things in her mouth at the same time. I asked the vet about it and he said in their experience it doesn't end up working out most of the time. I may give another shot but don't know that it will go any different.


     
  22. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Deb D. and Critter Mom like this.
  23. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Deb,

    How are things with you two today? Any further thoughts on the feeding tube?

    :bighug:


    Mogs
    .
     
  24. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Well I have left a message for vet to call me back to discuss cost, etc. I am thinking that unless by some miracle she has eaten a good amount when I get home from work that I shouldn't wait and I would like to take her tomorrow for feeding tube. I attempted syringe feeding yesterday, but it was a mess just to get a few ml of food into her. Although I think I have a bad syringe, it wasn't very good at sucking up the liquid-y food and then when I depressed the plunger it was hard to get the plunger down and it just splattered forcefully everywhere. So I probably need a new one. That being said, with the length of time she hasn't been eating I feel like she could be starting to have that liver condition and I don't think the tiny amounts she is getting is sufficient.
    I am really wishing I would have had pet insurance for her before all this mess began last summer. And I am really scared that if we manage to get her well that she will have a recurrence, like when I am gone for 2 weeks in May on a cruise. It seems like any stress makes this worse. :(
     
  25. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    What my vet explained to me is given the pancreas's role, pancreatitis inevitably causes bacterial imbalance => infection, which then puts us in a vicious cycle. So technically the infection is a side-effect of the pancreatitis.

    @Deb D. At my vet's practice they also give convenia (upto two months, I do the shots myself) for pancreatitis, and I have twice seen Quintus have good response to it. I had marbocyl too this time around because his gallbladder was involved in the mess.
     
    Deb D. likes this.
  26. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thanks...my vet did give her a shot of Covenia that lasts about 2 weeks plus 12 days of Zeniquin antibiotic. I didn't know you could give the Covenia shot yourself, interesting.


     
  27. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    Giving a shot to a cat is not very difficult, if it's an easy cat. You get practice with the insulin, Convenia is not very different.

    Bear in mind, regarding Convenia, that it's sold as "efficient for 10-15 days", but it's half-life is 7 (that means after 7 days half the substance is gone). With Quintus I see him flag after 7-9 days. ECID and in other situations I haven't noticed this "short convenia effect", but if you see him start going back downhill after that time when he had improved before, worth seeing if it's an idea to move the next convenia injection sooner to ensure uninterrupted antibiotic coverage.

    Zeniquin sounds good too, Quintus also had it.

    (As you will notice I do not share the skepticism of others regarding convenia...)
     
    Deb D. likes this.
  28. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I hope that Maggie has managed to eat some bit by the time you get home. I think your plan to go for the feeding tube is wise. Saoirse was willing to eat from my hand when she needed help but I think it would have been much more of a struggle for us if syringe feeding had been needed.

    I completely understand the fear you have of relapses but, all going well, with what you're learning here you'll find a food/med/supplement regimen that works well for Maggie going forward. I found that I had to be quite proactive and assertive when securing the right treatments from the vets for Saoirse but my persistence paid off and when they were in place they really made the difference.

    Sending more positive vibes for Maggie and some :bighug::bighug::bighug: for you.


    Mogs
    .
     
    Last edited: Jan 3, 2018
    Deb D. likes this.
  29. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Thanks. Maggie ate tiny amounts last night and this morning, talked with the vet and going to keep an eye on her and hold off on feeding tube for now. Her activity level is better, she even ran up the stairs last night. Fingers crossed that we are on the upswing. I have found the support on this forum from everyone invaluable, thank you!!



     
    Critter Mom likes this.
  30. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Deb,

    I'm very glad to read that Maggie's clinical signs are showing some improvement (quadruple anti-jinx!).

    I know I sound a bit like a scratched record but maybe ask your vet to give you an Rx for ondansetron, and possibly an appy stimulant and some pain meds if there aren't really big improvements in appetite over the next 24 hours. It could really help Maggie to eat better. (And keep an eye on her poop frequency!).

    Keeping fingers and paws crossed for your dear girl. C'mon, Maggie! Eat your fudz!!

    :bighug:


    Mogs
    .
     
    Stephanie & Quintus and Deb D. like this.
  31. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    I am picking up a supply of ondansetron tonight, she is due for her next dose of appetite stimulant tonight too. She has been getting pain meds but it doesn't seem like she is in pain anymore at the moment. Thanks.



     
    Stephanie & Quintus likes this.
  32. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Yay!!! I really hope it helps her. Do let us know how she gets on. (((Maggie)))

    A feline internal medicine specialist advised me that treating with bupe for a reasonable amount of time is beneficial during a flare even if clinical signs of pain aren't obvious (and cats are notoriously good at hiding pain :rolleyes::arghh:). Giving bupe as a precautionary measure can treat any 'occult' pain present. With effective pain management the cat is then less stressed and this can help reduce inflammation and resolve the flare faster.


    Mogs
    .
     
  33. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    Mogs is very wise and offers excellent advice. The change in appy with ondansetron can be remarkable. Fingers crossed!!
     
  34. Deb D.

    Deb D. New Member

    Joined:
    Jul 29, 2017
    Well good news...Maggie started eating fairly normal amounts again on her own yesterday, continuous to today!! Without even getting to try the ondansetron yet! She seems so much better, even acting playful. I am breathing a sigh of relief that maybe my life can get back to normal now. Thanks everyone and have a great weekend!
     
  35. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    Wow, that’s great!
     
  36. Carol & Murphy

    Carol & Murphy Well-Known Member

    Joined:
    Aug 9, 2015
    That's so great - however, as Mogs will tell you, and as I know all too well, it's best to continue the meds (especially the cerenia I think) for several days after they get better -

    You'll be prepared now, if she ever has another flare (I sincerely hope not though)
     
  37. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Such great news, Deb! I'm so pleased. (((Maggie))) :cat:

    I agree with Carol. It's definitely best to continue the anti-nausea treatment for a while. A flare takes a lot out of a kitty and giving them the continuing bit of med support will enable them to keep getting enough food (protecting their liver) and it gives them time for their digestive system to settle down properly and to make a good, solid recovery. Once you're sure Maggie is really stable you'll be able to titrate the ondansetron dose down, all the while checking that she can eat comfortably. If there's any sign of the nausea worsening then you can tweak the dose upwards again.

    Be sure to keep us posted on how Maggie does over the next few days and shout out if you need help with anything.

    :bighug:


    Mogs
    .
     
  38. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Deb,

    Just checking in to ask how Maggie's doing.

    :bighug:


    Mogs
    .
     
    Stephanie & Quintus likes this.

Share This Page