? Help with Pancreatitis kitty

Hello - Smokey had his first episode of pancreatitis in March and has two more flare ups since then.

When i notice it coming I immediately start zofran and mirataz and each time it has lasted about 3-4 days and then hes feeling good again .

This last episode was last week and it scared me the most because he had trace ketones.

My question is ... what do other people do to prevent a flare up .. and special meds, vitamins or food ? And what do you guys do during a flare up?

 

I don’t know if there is anything you can do to stop a flare. They just seemed to appear with Sheba.....Maybe stress. I remember once when I had to go into hospital she had a flare. She was very unhappy when I wasn’t there.
When Sheba had a flare I usually took her to the vet for subQ fluids (although in the last year I used to give the fluids myself). She was given an injection for pain (Bupe) and one for cerenia. That was usually enough most times to get her going again although I had ondansetron in case I needed it which I did a few times. She was on tramadol twice a day for arthritis so that was usually enough for the pain.
I think you just have to treat the symptoms and support him until it settles down again.
If you can have the subQ fluids at home and some Bupe, cerenia and ondansetron you can probably manage without a vet visit.

With the trace of ketones......make sure he is not dehydrated and give subQ fluids, and make sure he is managing to eat some food. Also don’t skip the insulin, if he’s not eating you should be able to give a half dose and monitor the BGs.

 

I do have the ondansetron , and mirataz at home. Tomorrow he has an appointment with the vet to discuss it even though he is better now . I'd love if she would give me subq fluids for at home but I feel like she wont.

How often did Sheba have flare ups ? And what food did he eat ?

 

Sheba normally had flares 2 or 3 times a year. She was fed a home made diet I made myself.
My vet wasn’t one to just let anyone do subQ fluids...I remember him telling me once that one of his clients gave them for their CRD cat at home. At the time I wasn’t really needing to do them at home as it was early in the days of Sheba’s flare ups. It wasn’t until I joined Fdmb that I realised that a lot of people did the fluids at home. But here is Australia I don’t think it is nearly as common as in the US. Eventually I asked the vet and he said OK. It was so much better to be able to do them at home.
I would ask the vet and see what he says. Explain how much easier it would be and better for Smokey not to have to go into the vet all the time. He may show you how to do them, it isn’t hard. I would also ask for some cerenia and some type of pain med to have at home as well as pancreatitis is painful.

It is best to be prepared at home In case of a flare, as I found the flares always happened either after hours or weekends when the vet wasn’t opened.
Let us know how you get on.

 

My cat’s flares also seem to be at least somewhat stress related. She’s had 4 in the last two years and they were all either in December/January when we travel for the holidays or April/May which is hairball season for her and hits her hard because of her IBD.

When a flare starts I take her into the vet for a cerenia injection as I can’t give her the pills, and fluids. At home I do bupe and ondansetron and make sure to feed her whatever she will eat, which is usually dry food, tuna, and squeeze tube treats. My cat has never needed fluids more often than the initial round at the vet, but it definitely may be beneficial to ask your vet about doing them at home. I’m in a Facebook group for pancreatitis and I’ve seen a lot of them mentioning giving their cats pancreatic enzymes, but I haven’t looked much into it

 

What group is that ? I'd like to join . This is all very new to me .

He has had 3 flare ups in 4 months though .. which scares me a bit.

 

I think it's Cats with pancreatitis

 

The one Chris linked is correct

 

My cat Buddy has chronic pancreatitis, I keep pain meds at home along with the anti-nausea meds. The last really bad flare was this spring and I took him in for I.V. fluids for 3 days and that was a game changer. Buddy, also takes Onsior every other day and that helps a lot. I have been talking to Tomlin & Amy about the use of prednisone, which Tomlin uses and helps him a lot. Buddy's vet is aware of the use of prednisone for pancreatitis and the possibility of Buddy starting to use that.

 

Hi. I am so sorry to hear about the flares! NOT fun! Tomlin has required Prednisolone to manage his issues. Some cats may luck out and have one episode, which for some cats, they can be severe and require hospitalization, but then they never have another one. However, there are some cats who will develop chronic pancreatitis that is best managed with Prednisolone. Some will require it during a flare and be able to have it slowly discontinued just like with the other supportive meds, while others will need every other day dosing and for some, every day dosing is required for them to stay well. We tried and failed multiple times to slowly discontinue Prednisolone and manage Tomlin without every day dosing. The inflammation would creep back and he would have a flare. So, we found the most effective lowest dose to use when he is doing well and then we increase it slightly when he is in a flare. We also use Cerenia and add Zofran if needed to manage nausea and then Buprenex injectable to manage pain. Subq fluids are also helpful. If a cat is in a more severe flare, IV fluids at the hospital are a game changer. That is the only way to perfuse the pancreas. Sometimes it is an option to take them in for a 12 hour session and see how they do at home and if needed bring them back as Teresa did vs overnight hospitalization for days. It all depends on the severity of the flare.

The only other note is that there can be underlying GI issues that are aggravating or causing the pancreatitis. In that case, if the primary issue is IBD, depending on where in the GI tract the issue is, a drug like Budesonide vs Prednisolone can be helpful. Budesonide will target the gut and therefore **possibly have less of an effect on BG. The caveat is, depending on the gut health and the cat, Budesonide can sometimes have a greater systemic effect in one cat vs another and then you will see an increase in BG. There are mixed results with Budesonide but it is worth a try if there is evidence of a primary underlying GI issue causing the flares.

Stress and diet can definitely also be an issue so it is another ECID scenario where sometimes it’s trial and error to get to the bottom of the exacerbations as well as the management of flares with meds.

 

Thank you for all that information!! I just got back from the vet - I need to find a new vet ASAP . She seems like she just doesnt have knowledge on diabetes or pancreatitis. She tried blaming these flare up on his dental disease (grade 2 or 3) . I dont see how that could be causing it considering he has an episode ones a month and it lasts 3-4 days .

 

Follow your gut and move on! I actually have a local vet and then 3 internal specialists, one GI, one Endo and one nutritionist, that work with us with Tomlin. I have also done direct consults with specialists at Cornell and my vets have consulted with TAMU (pancreatitis researcher and subspecialist) and UPenn diabetes center. I manage this like I would manage our own care.

I would highly recommend finding a new vet if you aren’t able to have a productive and helpful convo and even more so, find an internal medicine specialist (even better is internal medicine with a special interest, training &/or research with endo &/or GI). They will have the additional education, training, specialization and experience needed to better help with these complicated issues. Great ones are also on top of the latest information regarding treatment/management.

 

The pancreatitis is NOT caused by dental disease. Definitely time to move on. If you let folks now about where you live maybe you will get lucky and someone will have a good one. Hope so.
Stress and vet visits were triggers for Max.

 

I have had problems with miratazpine & ondansetron used together, I talked to Buddy's vet and some kitty's do not do well using these together.

 

I used cyproheptadine instead of mirt. A tiny sliver has worked for my cats.

 

Me too. I liked using the cypro better because I could give it more often (if needed) and it also wore off quicker. Just a tiny bit would make China go looking for the nearest water buffalo...lol

 

I agree. Move to a new vet.
Sheba has no issues at all with her teeth but had pancreatic flares.

 

I actually do not use Mirtazapine anymore with Tomlins flares. I find that if Tomlin doesn’t want to eat it is because he either has nausea &/or pain and if those are addressed with medication and also maybe a little help to get started again by changing the smell &/or texture (will warm the food and add some hot water,smash it and make it soupy) he will eat. He had one flare that I had to syringe feed him a few times to get him back on track and to make sure he got his necessary amount of food in for the day. The key is to try to medicate so that he doesn’t experience nausea or pain again after eating or he won’t want to eat the next time. It is important to discontinue any meds carefully and slowly, one at a time, to make sure he is feeling ok without them and continues to ear. The problem with oral Mirtazapine or the transdermal Mirtaz is that they essentially force the cat to eat and that is not necessarily a good situation if they are nauseated or in pain .

 

Pancreatitis is also very common with diabetic and CKD cats. I’ve read a lot of research and vets don’t know why.