Frequent Vomitting: Pancreatitis/IBD with Diabetes

S

Shorshe’s Mum

Member
Hello All,

Shorshe successfully had the surgery of her mast cell tumour on paw (biopsy report in her spreadsheet), biopsy of ear mass (turned out to be granulation tissue attached to tympanic membrane) and a CT scan on 28 March.

Since then her intermittent vomitting has only increased in frequency. The endocrinologist suspected it was subclinical pancreatitis since her FPL levels are normal as well as her USG images. A Senior vet of internal medicine suspects it might be pancreatitis or IBD given her low B12 levels. The vets suggest to change her food a try an elimination trial. But hypoallergenic and z/d food has very high carb. LID diets are almost not available here (Thailand) and whatever I have tried she rejects (Ziwi peak venison air dried). Recently, in my bid to shift her to more wet food based diet I have been giving her tuna based wet food (Regalos and Tiki cat)—so it might be an allergy to that? She is also a bit itchy and has been put on some skin supplements and anti-histamine.

Additionally one neurologist classified her twitching as seizures but the prescribed phenobarbitol didn’t suit her (intense vomitting). She suggested another medicine (levetiracetam) but another neurologist I consulted said she doesn’t have any other neurological symptoms and I should not give her any medication. I am trying her on vitamin b6 supplement for now as I read a paper which suggests older, thinner cats need to be supplemented especially if they are on a high protein diet.

Rehgarding a diet trial for an extremely fussy eater who is on daily cyproheptadine to enhance appetite what are your suggestions @tiffmaxee @Wendy&Neko? She is currently on Dr Elsey’s Rabbit and chicken and Salmon (hypoallergenic). The latter she doesn’t like much so has to be mixed with the rabbit flavour or some other food,
 
Having found this out the hard way, some of the more common (and popular) proteins for cat foods can be more common sources of problems. I have a kitty with IBD who I fed an entirely poultry diet for years. Turns out what I thought was a good diet is a common problem. Beef and fish can also be problems.

With IBD, novel protein is what you want to look for. If your choices are limited in Thailand, can you source the supplements and make a raw diet for Shorshe? Many of us use a pre-mix which contains all of the supplements to a make a diet nutritionally complete but I doubt you'd be able to find something similar or have the product shipped. On Dr. Lisa's website (the site where the food chart we use is located), she has instructions for preparing a nutritionally complete raw or semi-cooked diet.
 
What were her B12 levels? Are you supplementing it? I'm not familiar with just B6 being recommended.

Besides pancreatitis and IBD, small cell lymphoma is another possibility given the symptoms you describe. Don't panic about the SCL, it is treatable and a majority of kitties treated go into remission. The SCL kitty snoring on my husband's lap was diagnosed 7 years ago. She also has IBD, and that's harder to treat as what she likes one week, might be garbage the next. :rolleyes:

Fish is indeed a common allergen. A tuna based diet is not a good one long term. Making your own food is the best way to control the ingredients.

Have you talked to the vet about an anti nausea drug such as ondansetron or Cerenia (maropitant)? It's best to treat nausea first before giving an appetite stimulant or they can develop food aversions. Cerenia/maropitant will also help with the vomiting.
 
Thanks do much for the tips.
Her b12 levels were 144.
She is recieving weekly b12 shots (250mcg)

The B6 is for the involuntary muscle tremors/myoclonic seizures. This article talks about which cats should receive supplements https://www.nature.com/articles/s41598-024-52367-y

So cerenia is only available in injection form in Thailand which the vet says cannot be used for more than 5 consecutive days. I am giving her Onsia (ondansetron) 1-2 times per day. Onsia doesn’t seem to positively affect her appetite. I am also wondering if Cerenia tans can be used indefinitely? The vial of injection is over 200 USD. But not sure I can source cerenia tablets without prescription from US/EU? It would also help my other IBD-Traiditis cat, Kaju.

@Wendy&Neko how did you diagnose SCL? From my understanding a surgery to get multiple biopsy samples from the intestine is the only way to distinguish between IBD and SCL? I was advised against it as the initial treatments of steroid and eventually chlorambucil is similar (budesonide, which Kaju, my cat with Triaditis is on now).

Unfortunately, handling meat is done extremely unsanitarily in a very hot and humid climate here. So I am not keen to feed her raw. I can make cooked home preps though, and I have seen some recipes online and links probably from Dr Lisa’s website. But I have limited meat options here. Among “novel” meats i think the following are reliably available:

1. Duck
2. Quail/quail eggs
3. Crocodile
4. Lamb/Goat

Which would you recommend for an initial trial? Should I try her with small amounts of these protien without anything else to start with to see if she reacts negatively? She is extremely fussy eater, so it will probably just take months to get her to try one new thing, (best of luck to me).

I have also seen some commercially prepared barf diets but they are mostly for dogs and include fruits and veggies.

your help is so so appreciated.
 
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Ondansetron doesn't last long in the cat, you can dose it 3-4 times a day if giving in pill form. Dosing is 0.5-1.0 mg/kg of cat, every 6-8 hours. Some vets also underdose, giving you the injectible amount which is half of that. Plus it lasts longer.

This document has guidelines for dosing, see top of page 253:
There is no mention of limiting how long you give Cerenia (maropitant is the generic). Neko was on it a long time. There used to be a 5 day limit before some research was done, but that was ages ago. There is a generic version of maropitant available now, at least in North America.

Latest SCL kitty (I've had 3) was diagnosed with an endoscopy. But that can only be done if bowel thickening is in a place the endoscope can reach - ie. not the middle.

Treatments involve similar drugs, but not used the same way. Cats with SCL get prednisolone to start (or budesonide if diabetic) and a chemo drug called Leukeran (chlorambucil is the generic). Typically the prednisolone can be tapered down after a few months when symptoms subside. Sometimes the chlorambucil can also be removed if kitty is in remission after a year or two. With IBD cats, a novel protein, a good probiotic and prebiotic like psyllium husk fibre are good. Diet makes no difference to SCL cats. Some IBD cats need to have prednisolone. My IBD kitty is on it full time. I tried tapering it off, or lower dose, and it didn't work. For really severe IBD, chlorambucil may also be given. However, you only want to give chlorambucil if really needed (ie. SCL), because as a chemo drug, it is itself a carcinogen.

If she can't do chicken, I might try lamb or goat to start. Or crocodile, whichever is cheaper. Try small amounts of the meat by itself first.
 
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