It may show up in the ultrasound but a snap fPL will tell you yes or no pancreatitis and a Spec fPL will give you a number as to how severe it is.
They are both NOT on the routine blood panel and need to be ordered separately.
Atopica is oral cyclosporine and the number one side effect is anorexia, vomiting, diarrhea, etc. A small cohort had some elevated liver values and Sir Thomas definitely has something go on with his liver. Something is definitely causing issues with his liver for all of his liver values to be elevated. The ultrasound should definitely help with diagnosing pancreatitis. Because the liver is so inflamed and so close to the pancreas, I wouldn’t be surprised if the spec or snap fPL is elevated even if he doesn’t have pancreatitis. His bilirubin is really high which makes me question if there is a gallbladder or bile duct issue going on.
I wish they had run a full superchem panel to see what his kidneys look like. His potassium is definitely too low. I don’t agree that he’s not diabetic.
I hope you get some answers. Poor, sweet boy.
Thank you both! Just got off the phone from the vet. I hope I'm understanding this properly, this is all brand new to me. They think his potassium was low due to not eating properly for so long, gave IV with potassium and hydration.
So the vet and specialist said they expect the pancreas to be inflamed regardless due to his liver damage, so they are going to treat it as if it is pancreatitis and they have done the corresponding IV and meds in clinic. They have also tried anti-nausea and an appetite stimulant, and have had no luck getting him to eat so have been syringing him food, which is is super unhappy with but ya gotta do what ya gotta do in this case, short of a feeding tube, which is an option we'd like to avoid if possible. They will be sending me home with an appetite stimulant and an antibiotic to treat the inflammation (of the liver I think?), and I believe a liver support pill.
They said his kidney's were not great, but also not classified as diseased, but they would expect him to likely develop kidney disease in the next 5 years.
I asked about the atopica, and they said there might be some correlations there but it is hard to know. They said it is possible it has had an effect on his liver and kidneys, but it is also possible as a immune suppressant that it was keeping some of his symptoms at bay, we wont know which one is which until we go off. He hasn't had any atopica for 8 days and his appetite continues to get worse and worse so they don't think it is the entire picture. They said we risk possibly some symptoms getting worse getting off the atopica, but we won't know for sure if it is also causing problems unless we stay off for one month and re-evaluate that (so that's what we are doing- no atopica for 1 month then re-evaluate.
I asked about bile duct and gall-bladder being issues, and they said they were able to rule that out (I'm not exactly sure how).
Since he has not had insulin since the last time I gave it (none yesterday or today), as of today, his numbers have been down to the higher teens when stressed, but have been consistently down around the 11 mark when he is resting, which they said given he will be more stressed there than at home, is pointing to him not being a "true diabetic." They did say, though, given all the conditions, if they were to give him a steroid to increase his appetite it would ensure he would become a "true diabetic" and he still may, but they feel it would be caused by this inflammation, not the other way around which my original vet thought. They still want me to take his blood sugars consistently 4 times daily.
My head is seriously spinning. Thank you for taking the time to read through everything and advise me. I get to talk to one more vet at 6am tomorrow morning (it is 11pm here now). If anyone sees this and has any further questions you guys would advise, I am all ears! They will send him in with an appt to be re-evaluated in 2 weeks and I am supposed to try to encourage him to eat and syringe feed him last resort if he isn't getting enough calories.
So far my questions are:
How much do I have to see him using the litter before I'm concerned?
What signs do I have to look for before taking him back to the ER?
Can I get an emailed copy of all the blood lab work?
What numbers should his blood glucose stay within? Outside what range do I call again to re-evaluate?
What times of day would should the BG be taken consistently? At what point/ range should I take them more often?
When do they expect his appetite to return if all goes well?
At the 2 week follow up can we do a Spec fPL as well?
Did they do a full superchem panel, if so would that be useful at the 2 week follow up as well?
Many thanks everyone. I am mentally and emotionally drained so I am going to go get some sleep before I pick him up in the morning so I can rally to be there for him
. Thanks again!
