Thanks for the advice Libby. Would everyone agree to start with the buprenex? It looks like it has to be compounded. Is that true? If so, it's actually easier for me to get (closer) than my vets from a place the vet will call to compound it.
IMHO, if this was my kitty and that was her spec fPL reading, I would start pain meds - buprenex being my preferred choice.
See
Dr Scherk's paper on Feline Pancreatitis:
"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."
Also, a more recent paper:
Idexx Lab's Treatment Recommendations for Feline Pancreatitis
"Pain Management
Abdominal pain is frequently recognized in dogs with pancreatitis;
however it is rarely recognized in cats. Nonetheless, many cats will show clinical improvement if provided analgesic therapy. Because of this, many experts agree that pain management should be provided in all cats with acute pancreatitis. Opioid therapy is recommended. Fentanyl transdermal patches have become popular for pain relief because they provide a longer duration of analgesia. It takes at least 6 hours to achieve adequate fentanyl levels for pain control; therefore one recommended protocol is to administer another analgesic, such as intravenous buprenorphine, at the time the fentanyl patch is placed. The cat is then monitored closely to see if additional pain medication is required.
Cats with chronic pancreatitis may also benefit from pain management, and options for outpatient treatment include a fentanyl patch, sublingual buprenorphine, oral butorphanol or tramadol."
Buprenex does not need to be compounded, although I've seen some folks here get the compounded version, not sure why they did so. (compounding is probably more expensive). It is a tasteless (yes, I've tried it) clear liquid, and is one of the few meds that does not turn Meowzi into a drool monster. Is your vet able to call the prescription in to a local vet hospital or ER closer to you? That's what our back-up vet (also 40 mins drive each way, in good weather) did; he called it in to our acupuncture vet (20 mins away) and we picked it up there.