Nursing a Cat with Pancreatitis and Diarrhoea: Advice Needed

Hi all,

Saoirse's nausea has subsided now she's just eating chicken breast and broth mini-meals and she has her appetite back after the pancreatitis flare-up but I think she may still have diarrhoea. She hasn't passed any solids since Friday's large, off-coloured, squidgy stools and a later identifiable splurge of beige pancake batter-ish diarrhoea. No obvious whiffs or colours from any deposits to give helpful hints about whether it's urine or very watery, very pale diarrhoea (I use wood-based clumping litter). She's visiting the litterbox more than normal (usually 2 piddles every 24 hours, and 1 stool every 24-36 hours) so I'm working on the principle that she is probably still passing watery diarrhoea.

She is taking Pro-Kolin (kaolin paste with gut flora stuff), and the vet has said it's OK to give her Fortiflora (which she likes) but I forgot to ask how much to give. I'm petrified of doing anything that might trigger another attack of nausea but - wuss that I am - I would feel very embarrassed about calling the OOH vet again because I don't want to be a pest. I've looked at the packet and online but the dosing guidelines I've found are very general.

I'd be so grateful for advice on how to nurse a pancreatic cat with diarrhoea. I'm so worried about triggering another bout of nausea. In particular:

1. Is it ok to leave broth available all the time to help her rehydrate or could that upset her tummy? (Tried flavouring water with broth but she wasn't having any of that.) She is relatively well hydrated with the 18g chicken / 18ml broth I've been giving her every 2 hours, but is that enough given the diarrhoea?

2. Can Fortiflora cause nausea? Any suggestions on how much/little to give? (I've given her a tiny tip-of-a-kitchen-knife's worth so far.)

3. Now that she's getting hungrier, I'm caught between a rock and a hard place. I don't want her hunger to result in a bout of stomach acid (her only real major problem before this flare-up) but I also don't want to overload her pancreas either. Any recommendations on portion size? (Saoirse weighed in at 4.43kg before a meal earlier.)

Saoirse's going to see the vet tomorrow to get checked over and to get some fluids if needed. The skin-pull test seems fairly ok at the moment. Also she did an "identifiable piddle" a little while ago, and it wasn't as big as normal, so does that mean the fluids are being lost in the diarrhoea instead?

If she had just had a bout of diarrhoea I'd have some idea what to do, but with the pancreatitis I'm so worried about upsetting her system again that I'm stuck. Any help or advice would be very, very welcome.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Forti Flora is probiotics in a animal digest. Digest is the stuff they spray on dry food to get cats to eat it. Many cats adore Forti Flora and will even binge.

Try putting just a pinch on a tablespoon of food and see what she thinks. If she binges, you'll know that less is more. If she turns up her nose at it, you'll see it isn't enough to prompt eating. In other words, experiment slowly.

Are you giving Pepcid AC? 1/4 tablet, about 20-30 minutes before a meal can help with that.

A bit of active play, if she is up to it, may help trigger the catch-kill-eat-eliminate-groom-sleep behavior cycle. That can prompt eating.

Picking up the plate, stirring up the food, and offering it again sometimes prompts a few more bites (new food!)

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Hi BJM,

Thanks for replying. I feel so ... lost. :sad:

She hasn't needed Pepcid since 6pm (local time) last night. She's really keen to eat and, bless her, she's enjoying the chicken and broth very much. I'm so pleased for her after that heart-shredding nausea at the end of last week. She's in better spirits today, too.

She likes Fortiflora. I was using it to make the bland Bozita Sensitive DIet & Stomach food a bit more appetising for her. Before her appetite stalled, she was doing amazingly well on the Bozita/FF combination. Her coat was getting shinier and softer by the day. Before this flare-up, Saoirse's only problem with the pancreatitis was if she fasted too long. I think there was a build-up of stomach acid and that made her vomit any time her tummy empty. Feeding the mini-meals while on insulin was OK because the insulin treatment was helping with appetite stimulation. Once she had to stop Caninsulin because of the big drops and her low numbers, that virtuous circle was broken.

Now that she's eating little and often again, her nausea has thankfully disappeared, she has a really healthy appetite and eagerly awaits her next meal. (Note: I don't know how much that is still being influenced by the dose of mirtazepine from 2 nights ago, but she's not displaying the crazed, desperate hunger that the drug induced in her on Saturday evening. The dose was supposed to last 48 hours. That time period has just elapsed so I don't know if it's still a factor in her improved appetite. I don't want to give her another dose if I don't have to.) She would actually eat more than what is offered at some meals, but I'm restricting her to the 18g of chicken breast (lightly poached). I've increased the amount of broth over time.*

I just want to know if I give her more broth could it make her feel sick again. Same for how much Fortiflora to use. The only thing I can think to do about the latter is to put a tiny pinchette on each meal and see how it goes. I wish that Purina had put some sort of guidance on the pack.



* So far today her calculated fluids out are approximately the same as fluids in. All the secondary monitoring is really paying dividends, as indeed you said it would. Great advice. Thank you. :smile:

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

I just posted on your earlier thread. In short ondansetron or cerenia for nausea, flagyl for diarrhea. I hope your cat feels better soon.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Thank you for the meds list, tiffmaxee. How often / how long do kitties need to take them for?

She just started lip-licking again, so I've lifted up her meal for the time being and given her some Pepcid. I'll ask our vet about the other meds when we see him tomorrow.

I pray that she will feel better soon, too. It's doing my heart in to see her going through this. :cry:


Edit:

Just checked the other thread. Thanks for the additional info. Fusses for your little one. :smile:

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

How long the support is needed depends on your kitty. The first time for Max he was on ondansetron for months. He was getting 1mg twice a day but apparently it wasn't enough for him so I also was giving him cyproheptadine, an appetite stimulant. Every time I tried to cut back he was eating less. Finally a vet suggested to me that he wasn't getting enough ondansetron and once we upped it to 2mg twice a day I was able to cut out the cypro. My advice based on my experience is to continue support for at least a week or two after eating is normal. Then cut gradually. If the appetite decreases, go back to what was working. It is trial and error. Once Max was on the correct medication and dose of nausea med, he didn't need any appetite stimulant. Since his problem is chronic, with relapses I often gave him cyproheptadine if the ondnasetron didn't get him back on track after a couple of doses. I never needed the cypro more than a day or two. Vets often give mirtazapine and with my first sick cat told me it would help for nausea but it didn't. It also made Tiffany very hyper and vocal. Starange that just a crumb of cypro gets Max eating, like 1/8 of a 4mg pill yet he needs the larger dose of ondansetron. Cats can have a bad reaction to mirt and cypro is the anecdote for it should it happen. Cypro leaves the system quickly and can be dosed up to 1/2 a pill twice a day which I also like better than mirt. If I can help at all ask me any questions that you have and I will get back to you.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Idexx Round Table:
https://www.idexx.com/pdf/en_us/smallan ... rticle.pdf

i hope this helps explain things.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

It is a good morning. We have a great appetite. We have no nausea. We are enjoying our food. And thank goddess we have solid stools.

Can't describe the relief!

Saoirse seemed to get better in the small hours of the morning. My heart lit up when, for the first time in over a week, she came and snuggled up to me. My girl's eyes are getting their sparkle back. :smile:

Thank you so much for helping us get through yesterday. Back later ...

Blessings!

Edit:

Mild nausea at 10:15. Pepcid sorted it out fairly quickly, but I need to talk to the vet about a better anti-nausea treatment. That and Saoirse's food going forward.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Just for future reference, does your Fortiflora come individually packed in the 1gram sachets? Mine include instructions to feed one packet daily or as instructed by your vet. I usually end up just dusting the surface of a bowl of food and that's enough. I can manage to get 4 small meals a day out of a single packet. It hasn't seemed to worsen pancreatic symptoms.

Glad to hear she's feeling better today! Hope she stays that way. :smile:

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

That is how mine came from my vet. I guess they are a gram each I can't find it listed on the individual package.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

They aren't listed on the individual packages, but the packaging they came in says it's 30grams of product and there are 30 packets.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Hi Hellen,

The Fortiflora is in 1g sachets. I had been putting it on Saoirse's Bozita food while she was on Caninsulin. The Bozita Diet & Stomach formula is quite bland so I sprinkled a teensy dusting onto the food and mixed the lot up with a bit of water to make it more appetising. Saoirse really liked the flavour and I think it was doing her some good in terms of helping her to absorb nutrients better. I wondered if the Fortiflora might help stop her dreadful diarrhoea but I was worried about giving her too much and making her worse. Everything she ate was going through her for a shortcut. I'm so relieved that the Pro-Kolin worked and that she's passing solids again, but I'd like to reintroduce the Fortiflora again at some stage. Being honest, right now I'm in a complete heap about how, when and what to feed her ...

Unfortunately when she had to stop Caninsulin and her pancreas started to flare up she developed an aversion to the Bozita. It's so infuriating because it was really doing her good. Her fur was getting shinier and softer by the day and her BG numbers were getting better. I can't get over the difference between how she was last Saturday week (looking like a really young cat again) to how she is now (coat in tatters and struggling to eat). My baby girl ... :cry:

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Saoirse SITREP:

My little one started well today (apart from the uptick in her BG ) but her pancreatitis symptoms started re-emerging by lunchtime. The lip-licking, then the uncomfy meatloaf (with head down for the first time). Saoirse was starting to turn away from the chicken and broth. (If she were to develop an aversion to that I'm sunk.) Thankfully this time I was a bit more clued in and we took a trip to the vets this afternoon. Her hydration is OK in spite of the diarrhoea at the weekend, so at least I got something right at long last. (I feel completely out of my depth with this. :sad: )

The vets took a blood sample for a full workup including B12, folate, and another spec fPL. As soon as I gather a urine sample they'll run tests on that, too. That way we will establish a baseline for future reference and we will be able to create a comprehensive treatment plan for my little baby girl. They're also going to do the TLI test so that we know one way or the other about EPI. The wondering about whether or not she has an insufficiency is wrecking my head. I can't cope with the uncertainty. (I was very shaky during the vet visit, and they could not have been more understanding. I appreciate them so much.)

Saoirse received some Cerenia for her nausea. She meatloafed for a bit after we got back from the vet but now it seems to be helping her. She's back eating and enjoying her chicken and broth (phew!). Her appetite is still good, thank God. She also received a vitamin injection, and an antibiotic for a very probable low-grade UTI. No pain meds at the moment, but the vets are working on refining her treatment protocol over the next few days. Her discomfort seems to be easing as I write. I feel better for knowing she is starting to get more help. (((Saoirse))) cat_pet_icon

I can't thank you all enough for your support, your advice and your tremendous generosity of spirit. I don't know where I'd be right now if I had not found this wonderful community.

((FDMB))

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

I hope they sent you home with cerenia. It needs to be given once a day until she gets over this. It comes in pill form and also you can inject it under the skin but it does sting some cats and did sting mine. Your vets are doing all the right things.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

HI Elise,

Yes it did sting. I asked the vet about the Cerenia this morning, and I think it's only available in the injectable version over here. He is in the process of getting in all necessary meds for her. Including glargine ...

Saoirse's BG levels are heading upwards at a rate of knots. We started Saoirse back on Caninsulin until the glargine arrives (should be tomorrow).

Elise, would you mind my asking what sort of quantities and how often you feed during a flare-up and also for maintenance? I know that what works for one puss might not work for another, but I'm floundering here. I'm trying to get ideas about what has helped other cats that might help me better work out a feeding plan that works for Saoirse. I am currently feeding Saoirse small quantities of chicken & broth (approx 18g/18ml) approximately every two hours. (I settled on 18g because monitoring of Saoirse's feeding patterns indicated 18g as the amount at which she usually stops eating, even if there is more food in the bowl). Before the flare-up, I used to feed her once every 3 hours (any longer than 3½ hours and she might vomit). I don't know what's right to do now. Sometimes Saoirse's still hungry after her meal and I'm afraid to give her more. Sometimes she will leave some food in the dish and I worry about whether or not she has had enough to prevent a vomiting attack. I just don't know what to do to help her, and I'm petrified of making things worse for her.

I don't know what puts strain on the pancreas. She produced a tan/yellowy semi-cowpat overnight which is a step back from the previous night's properly-formed stool (though I don't know whether or not yesterday's medications might have affected things).

My heart is in the basement. :cry:

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

We are still dealing with Shadow's pancreatitis and he still experiences some bouts of nausea and lethargy, but he's slowly getting better. His Spec fPL dropped from 5.6 to 4.5 in two months, so things are gradually improving. We are still awaiting the EPI test results.

Like you, I feed 10-20cc's at a time (for a total of about 180cc/day) and space them anywhere from 15 minutes to an hour apart depending on how well I see him taking his food. Since he's syringe fed, it makes things a bit easier. If he doesn't want to eat, he will actively push it away, and I never press the issue. He doesn't seem to have any food aversions despite being syringe fed for so long. I try to ensure that his feedings are toward the first half of his insulin cycle, with one 10cc snack around +8 or +9 to combat excess stomach acid. The vomiting has greatly improved since we upped his dose of Pepcid.

Do you administer subcutaneous fluids at all? In addition to pain control and anti nausea meds, the fluids are a main aspect of therapy. Is that an option where you are?

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Hi. Once you get the nausea controlled better you could switch to ondansetron (generic zofran) which is a human medication and comes in pill form. Do you go to a cats only vet? I ask because cerenia is only approved by injection for cats but we all use the pills here which are approved for dogs.

Yes, you need to feed small amounts of food every few hours even if she is still hungry. The way my vet described it is they get hungry so they eat but eating more than a small amount makes them feel sick. You want to feed enough food to maintain their weight if they are at the right weight. If underweight, I wouldn't try to put weight on until she is feeling better. If she vomits that much there is a good chance she has IBD. Has your vet mentioned that? Once things settle down you might want to experiment by feeding her a novel protein, one she has not eaten before. Unfortunately she might be allergic to chicken. Fish and beef are often the culprits. You could try duck, venison, kangaroo, any protein she has never had. You need to read the labels because often a food will say chicken, like fancy feast classic chicken, but it does has some fish in it.

If the diarrhea persists, ask for flagyl. There are two types and one is better for cats than the other. Also the dosing of it has a wide span. My vet prescribed too large a dose and I was going to give less but luckily Max never needed it. He has only had diarrhea a few times and it left as fast as it came. I'll look up to find out which is the correct flagyl if you need it. There is a yahoo group for pancreatitis that would be a good idea to join. There are some really knowledgeable people there which is where I learned a lot. That and the lymphoma and kidney lists, unfortunately. Even if you never post there are lots of articles to read and info on the site.

It sounds like she is doing much better and you might not need any of this. Keep us posted. cat_pet_icon

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Hi Hellen & Elise, :smile:

Just a quick post to say thank you for your posts. We had a bad day yesterday and small hours of today, so I'm too exhausted to reply properly right now. Just wanted to tell you that Saoirse ate very little during the middle of the day today, and she slept a lot. The good news is she seems better this evening than she has done in days (thank God!). New meds arrived (ciproheptadine & metoclopramide).

The additional timed feeders arrived today so on tonight's PM cycle I've incorporated your suggestions into a new feed schedule for Saoirse with smaller, more frequent meals to see how she gets on. Of course it could all go pear-shaped if she busts into the feeders. (I hope not: I'm desperate for some sleep. My own health's not the best. Saoirse is depending on me so I need to make sure I don't deteriorate.)

Thank you so much for helping us. I'm so grateful. Sorry I'm too banjaxed to post more tonight.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

(Apologies to readers for uber-long post.)

Thank you both. This is the sort of steer I was hoping someone could give me. I've incorporated these tips and now feed her nibs 8g chicken mince plus broth & water about once an hour. Granted she's a bit miffed that the service at Hotel de Saoirse ain't what it used to be (and my living room now looks like the kitty feeder equivalent of Mission Control) but this approach seems to be working better for her. :smile: WRT the insulin cycle, the hourly feeds aren't great for Caninsulin but it's only temporary. Saoirse is being moved onto Lantus next week. Its longer action should work better alongside her current feeding schedule.

This time last week I was really worried that Saoirse would need fluid therapy at the vets, but thankfully she likes the diluted chicken broth I've been giving her and she drinks it readily. Even with the diarrhoea last weekend she managed to get enough fluids on board and avoided dehydration. I use BJM's recommendations about secondary monitoring to estimate fluid in vs. fluid out. It has been an invaluable tool. Saoirse had blood and urine tests done this week plus two vet check-ups and they're happy with her level of hydration. Our vets were pleased that I was able to nurse her at home because it's much less stressful for her than a hospital stay. (They are wonderfully supportive. We're blessed to have them.)

It's a rural general practice (farm & companion animals). I don't know how EU legislation affects prescriptions: my vet said that Cerenia is only available in injectable form here. He has prescribed ad hoc metoclopramide for the nausea and ad hoc cyproheptadine for appetite. The combination seems to be working well for her at the moment. I've had to reduce her dose of cyproheptadine down to 1/8 tablet BID and only a small dose of the metoclopramide BID seems to do the trick for her at the moment.

I don't know how her current treatment protocol will stand up to the change back to a complete diet; a prospect I'm dreading. Most of the good foods seem too rich for her.

Before the flare-up, Saoirse's pancreatitis was almost asymptomatic. After initial diagnosis, the first vets instructed me to restrict her to twice-a-day feeding of w/d. With the imposed long fast, she vomited white foam a couple of times because of excess stomach acid. As soon as I changed back to more frequent feeding the vomiting disappeared. She very, very occasionally had some lip licking moments, but these were being managed well with a small dose of Pepcid (2.5mg). When her polyphagia disappeared and her blood glucose settled at the top of the euglycaemic range for a non-diabetic cat her appetite disappeared as well. That caused more problems with stomach acid, then the nausea, and you know the rest. What dose of Pepcid does Shadow take, Hellen?

I have discussed IBD with our vet. Prior to the problems with inappetence, I had transitioned Saoirse from RC Obesity Dry via Purina DM Canned (which she did not like very much) to Bozita Sensitive Diet & Stomach formula with a little sprinkle of Fortiflora. It's not single protein but it did contain a novel protein (elk). It does have a little bit of oat in it, but she was doing famously on it - both physically and BG-wise - until the inappetence kicked in and it all went south for us. This time two weeks ago she was on Bozita, almost in remission, and looking and acting like a cat of 3 or 4 years of age. It's crushing to see how poorly she is now by comparison. My stomach ties up in knots when I look at her spreadsheet colours - even more so given that her temporary diet is about as low carb as it can get. :sad:

I think it would help her to get back on the Bozita diet again, and so does our vet. It's quite bland compared to the majority of quality. low carb foods I've looked at, but I'm worried she may have developed an aversion to it. Do you have any suggestions on how to overcome food aversions? I'd be enormously grateful for any tips about how to reintroduce the Bozita without turning her off it completely.

I joined the Yahoo pancreatitis group but I'm finding it a bit overwhelming and difficult to get my head around. PTSD cognitive issues make unfamiliar things very, very difficult to grok. I'm familiar with the FDMB software from another forum I joined years ago so I kinda know how to look for stuff here, but I can't get my head around how the Yahoo groups work. I've signed up for the daily email digests but even those I find overwhelming so I have to stop trying to read them. I have read some of their beginners guides, and they were helpful.

So much love written between the lines. I am really sad that your little ones are poorly, but it gladdens my heart to know that they have such amazingly dedicated, warm and caring moms. :smile:

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Another place you might check for some ideas for the stomach upset is Feline CRF. Many cats with renal disease develop upset stomachs as a result of the build up in toxins. Slippery elm and aloe juice are 2 options which have been found helpful for some cats.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Metoclopramide (Reglan, right) is not a good med for nausea as cats don't have the necessary receptors for it. You can get ondansetron from thrivingpets.com and they are very reliable. Your vet can fax a prescription to them. I've used them for many years.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Hi BJM,

I've been dipping into Tanya's site: it's a goldmine of information. I'll be sure to have a look for more information about stomach acids there. BaileysMum recommended aloe juice to me and my vet is looking into the possibility of using it as part of Saoirse's treatment programme.

I had a look at slippery elm but I was worried about the carbohydrates. Would they be OK for a diabetic kitty?

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Slippery elm is fine. Lots of people use it here. You will be happier with ondansetron until the major diarrhea passes.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Hi Elise,

I did ask my vet about the ondansetron but he prescribed the metoclopramide. I'm not quite sure about how to approach him about the other medication now.

Edit:

The worst of the diarrhoea passed by Sunday. At the moment, it has gone the other way (no bowel movement for over 48 hours).

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

No feces for 48 hours after bad diarrhea is not unexpected since the diarrhea can really empty the bowels.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

That bit of timely reassurance is very, very welcome, Larry! She did pass one stool then a couple of runny/squidgy efforts since the worst of the diarrhoea. I hope she passes something soon.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Maybe show him the Robertson IDEXX Roundtsbke article? I think it might mention why the other one doesn't work well. It used to be the only thing to use until cerenia and then ondansetron went generic and became affordable.

NYW thrivingpets.com sells the tanker cerenia. I'm glad the diarrhea is over. My vet warned me that once that happened he may miss a day or so and that was when I could stop using it.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

I'm sure I saw that mentioned somewhere in the IDEXX publications as well, Elise. I've dug up a couple of articles I'd like to ask my vet about, but I'm really shy/nervous/awkward about doing so because I don't know how to approach it the right way. Id hate to do anything that might cause any offence to my vets. I have the utmost respect for them and I appreciate all they are doing to help Saoirse.

Thanks for the info on what to expect in terms of eliminations. I've never had a cat with diarrhoea before, never mind pancreatitis. It would mean so much to know that Saoirse was feeling better. I wish she could tell me so herself. It was reassuring to read what your vet said about stopping the Cerenia. I want her to feel better so badly.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Sorry I wasn't clear. Cerenia should not be stopped until the appetite is normal. It's the flagyl that can be stopped.

 

Re: Nursing a Cat with Pancreatitis and Diarrhoea: Advice Ne

Thanks, Elise.