? Prednisilone dose for 11# kitty ... 6/14 Yoyo AMPS 272

Yesterday 6/123 http://www.felinediabetes.com/FDMB/threads/6-13-yoyo-amps-279.230903/

Day 1 @ 1.88 Units Lantus

Good morning....I increased Yoyo's dosage of insulin and I also started prednisilone this morning. I was told that prednisilone will increase Yo's BG levels.....

Yoyo is very quiet, hopefully the pred will give him some hope for a brighter day. He did not want food this morning but he did let me finger feed him...I feel bad having him eat when he doesn't want food but if I am to continue with his insulin I need to make sure that he has some food in his belly.

Thank you again for all your prayers and concerns....Yoyo is trying to fight this battle with all he has.

Wishing you all to stay healthy and that all your Kitty's surf safely

 

We're pulling for Yoyo! Moey, Ittle and all of our civvies are wishing you a full and quick recovery. You can do it. Momma loves you very much Yoyo.
I pray things improve quickly for y'all.
Have a wonderful day Debra.

 

Thank you

 

I hope the pred will help Yoyo. It will most likely make his numbers go up and you may have to increase his insulin again to counter it. Sending prayers.

 

Debra, I looked at prednisolone that was prescribed for Tina before her FD diagnosis, and she had 10mg per evening. She is 12 pounds.

Much love and hope for improvement . . . Today!!!

 

Thanks Carla

 

Thanks Jan...so I guess I am starting out with a small dose.....I should probably give another 1/2 tablet tonight or I'll see how he does throughout the day.....

Did Tina have any side effects from giving her 10mg at night? Did it keep her awake? I read that it is best to give with food in the am and that at night time it can keep them awake

 

Instructions were to give in pm, and I don't know why! I found another bottle that instructed 5mg both morning and night.
It caused extra thirst and hunger, and gave pain relief for arthritis. It was given as a trial to see if she could move about easier.
Yo - get better baby please!!

 

Debra, we're wishing with all our hearts that between the pred, the fluids and cerenia, Yoyo will finally start to feel better.

 

Feel better little man

 

I gave the full dose of prednisolone all at once. I don’t think weight is taken into consideration with prednisolone. Some cats get an increased appetite which happened to one out of two of mine that had it.
Are you going to get an ultrasound? If so it should be done by a boarded radiologist or at least a boarded internist that does them a lot. Just another reason to get another set of eyes to evaluate. I keep hoping to see some good news when I heck each day. Prayers and hugs.

 

Hope Yoyo feels better soon. Ollie has chronic constipation, it's more from little motility now. She would just stand in box a wait for it to come out. She didn't strain just didn't have enough muscle movement to get it out. Have been through the pumpkin, miralax, lactulose, psyllium husk routines and each worked for awhile. For quite some time giving the psyllium husk 2 nights, then pumpkin and repeat that cycle worked well. Psyllium husk also help with anal glands and she gets Glandex. I've been using baby food pumpkin which to me is to pureed and doesn't work as well as Libbys pumpkin, it has more texture to it. I can't always get Libbys. Ollie also gets low dose of bupre every 8 hrs and will for life. We tried without and Ollie's glucose will just shoot up and if you touch her she reacts to pain, so she really needs it. Mostly for p'titis but also helps with pain when pooping. If Ollie strains she will vomit. Ollie drinks a ton of water and pees a ton. Subqs will help with with passing poop. If I miss one dose of bupre or anything to make her poop, she is very uncomfortable and will/can be sick. So keeping routine of giving works best. I don't worry to much if she doesn't go for a day or two anymore I was going crazy. If after 2 days nothing then she gets miralax added in and she will go.

Try the bupre for a few days, maybe there is pain somewhere you just don't know about. Maybe Yo doesn't have motility anymore, Ollie gets cisipride to help that. I never heard of pred for constipation though. Are you sure it's not pancreatitis?

 

I agree with Elise, usually weight isn't taken into consideration for prednisolone. I've seen 5 mg for a smaller dose or 10 mg for a larger dose and just given once a day. Having said that, my vet put the civvie on a 4 mg dose cause she was petite. Previous cat got 5 or 10 and he was bigger. Compounded chew treats are very easy to give.

Piling on the vines for a better day for Yoyo.

 

I hope that the pred helps Yoyo,and that he starts to feel better. Hugs and gentle scritches

 

Hi Paula....Yoyo is Not Constipated....he was given prednisilone because he does not want food and is very listless...he just lies down and doesn't move...sometimes I find him in another area, but not often.

He was confirmed to have pancreatitis and possible pyelonephritis....he has been drinking and urinating a gigantic flow....he isn't drinking enough to make that large amount of urine. Now he is getting fluids but that really has not made a difference in his output of urine.....he has been urinating large amounts since approx May 25...not normal....I have told vet over and over....that is why he is weak along with being anemic...low RBC, Low HCT and Hemoglobin.....I have not used bupre, I have it- I am just scared to use it as the vet said that it will make him more immobile and now I don't know if I can use it because he started prednisilone.

Why does Ollie urinate a ton and drink a ton of water? She sounds like Yoyo but Yo also has the anemia.
It's really something reading what you wrote....Ollie's symptoms sound so much like Yoyo's!!
They both have pancreatitis and drink a lot and pee a lot.

I also use libby's canned pumkin which is thicker and I have the baby food pumkin which is like water.
I have watched when in the past Yoyo has strained to have a bowel movement and then he vomited all over!

They sound like similar symptoms....accept Yo is very ill at this time.

Thank you for sharing about Ollie.....please let me know if you have figured out why Ollie drinks and urinates tons...thanks!!

 

Yoyo had an ultrasound on 5/27 with an internest who is mobile and came to the office......she found pyelonephritis, and normal pancreas and recommended the culture and sensitivity and a pancreas test anyway....urine came back Negative and pancreas test came back 4.3 which they concluded in pancreatitis. But I do believe he has pancreatitis since last June 2019....he was making facial twitches and weird face movements which may be considered facial twitches by definition....I did not treat it back then with cerenia and instead I used SEB (slippery elm bark) and it really helped him all this time.

I believe that the cystocentesis that he had on 5/20/20 may have caused an infection.
I believe Yo got an infection that went unnoticed too long and I should have started the zeniquin earlier than I did but he was given convenia which I was hoping would help the situation.

Since all of this happening Yo began to urinate excessively with large output and recently is drinking more. I just started pred today, so it is not from the pred.
Being anemic and urinating sooo much volume makes him weak.

He has NOT SEIZURED recently. He only seizured for about 2 days...I believe it was from the large amount of blood work that was taken on that day and with his anemia I feel he was too weak and he came home and had a seizure. He had a couple of little ones, lasted about 10 seconds or so...quick.

So one thing leads into another thing with Yoyo. He has a history of anemia for No Reason at all, never determined why, did several blood tests and the last time when he was a kitten I was told to do further tests that Yoyo had to be in Texas. I live in Florida- so that wasn't happening.

So that pretty much is a fast history of Yoyo.

Thank you for caring and checking in on my little kitty

 

Thank you Wendy. My vet is starting Yo with a low dose because I asked her to do that. She wrote 1/2 of a 5mg tablet in the morning and if tolerated to increase to a half tablet 2x day and then the normal dose is to give 5 mg 2x day.
Thank you for giving me the doses of the other pets, it helps me know that Yo is getting the right dose when I do increase his dosage. I was afraid to give the entire amount at first....but he probably needs all the help he can get....I should probably give him the other 1/2 of pill tonight...thank you again

 

Thank you Sonia....I didn't give him the cerenia as I don't think it did anything, some days I thought it did and than other days I didn't notice anything different....maybe just wishful on my part

 

Thank you Jan...at least I'm on the right path with the dosage.

 

After reading the history he likely is having a bad pancreatitis episode and hopefully the infection is gone. I’m so glad the seizures have stopped.

 

Thank you Elise. You are so positive that it gives my heart a little hope. Thank you for reading everything that I write. I feel like you understand what I am saying.....thank you

Not sure if you know this answer, but can Yo receive prednisilone and buprenorphine at the same time or the same day hours apart? ..... (I'll try and look it up on the computer and I'll ask vet on Tuesday when she is back at the hospital) ...thanks again for everything!! You have no idea how helpful you have been to me and I can't thank you enough!!

 

A good place to look for drug interactions is drugs.com. The two drugs you mentioned do not have any according to them. Max never had prednisolone. My cancer kitty did but she never had buprenorphine.

 

Thank you!!

 

I had a civvie that had both pred and buprenorphine - no issues. Neko had budesonide (another steroid) and bupe daily.

 

Did the buprenorphine make them very groggy or spaced out?

Do you give the meds together- at the same time or do you space them about 2-3 hours apart for absorption?

Thanks for your help Wendy

 

Don't know why Ollie drinks so much. Even with fluids she drinks a ton. Ollie is between stage 1 & 2 of ckd. She has symptoms of both stages but not all of either stage. Even though the urine sample in May had no bacteria, Dr thinks Ollie has polynephritis and it a stone lodged. The associate vet in other practice said same thing back in January. Was suppose to have ultrasound back then but Ollie Dr left the practice to open her own and wasn't set up yet then this virus hit so still waiting to get it done. Just finished 29 days of AB. She still puts out a lot, some of it is being unregulated and the fluids. I do think it more kidney disease though and have been monitoring her kidneys for about 1.5 yrs now. Tests come back normal, some levels high end one time but next time lower then different values a bit off. I try to find low phos food but no luck she eats them more than once. Now that ab is done I will use dmannose.

First couple of days in bupre she was more quite but she was sick and only got it every 12 hrs. Then when IM saw her it was upped to 8 hr dosing. You couldn't touch her at all because of pain. Over time dose was tapered down to what it is now. She isn't spacey or groggy however she was never an active kitty, she is the same activity level as my 17 yr old.

 

Depends on the dose. It's dosed by weight, but there is a wide range or dosing. I once had a civvie get a huge dose from the only 24 hours hospital I could find open on a Sunday (why always the Sunday ), anyway, the concentration was almost double his usual. I didn't notice and he acted like a drunken sailor until I halfed the dose. Neko was fine on her dose from the get go. Vetty said to give it at night the first dose, when they are going to sleep anyway.

I never did any specific with timing. Bupe was after a meal, you want some food in their tummy. Pred for the civvie tended to be an "appetizer" in a pill pocket. I wanted him hungry so I know he'd eat it. Neko's budesonide was at first a pill which I loaded into a gel cap with other meds, later a compounded liquid which was much easier to giver. I tended to separate a bit, just cause I didn't want to keep shoving stuff down her.

 

Hi Debra. I am sorry to read about what is happening with Yoyo. My T has chronic pancreatitis and has been taking Prednisolone for years. We use the least effective dose meaning when he is in a flare, he requires 5mgs per day but when is not in a flare we are able to maintain him on 3.75mgs per day. For some cats, they can get away with 2.5 mgs daily or even every other day, while for others, daily dosing &/or higher dosing is required to keep them out of trouble. There are also some cats who will have an acute episode, be treated and it is able to be discontinued. Time will tell what works and/or is needed short term and long term if it is pancreatitis-acute vs chronic.

I have given T Prednisolone in the morning, I have given it at night and I have also given it BID—so 1/2 dose AM and 1/2 dose PM. One advantage of BID dosing, and keep in mind ECID, is that by giving it 2x day vs 1x/day some cats have better symptom control throughout a 24 hour period. The other advantage is that it can be easier to manage insulin dosing. For the most part, like clockwork, I see T's BG increase +3 through +6 after given the prednisolone with the highest BG usually being around the +6 point. I have tried timing giving the insulin and Prednisolone so that the NADIR occurs with the spike in BG caused by Prednisolone, but given that T's NADIR does change and there also can be some variability at times with specifically when the Prednisolone will cause the highest increase in BG, I just give them together to be safe.

I do give Buprenex (injectable) when T has a flare without any issues. He only requires a low dose and actually comes to life and is brighter and more active once it stops his pain vs. it knocking him out which is often what will happen if the dose is too high. I will also notice he is able to sleep comfortably all stretched out vs in a meatloaf/guarded position. Cerenia is great as is Zofran for nausea and I have used them both at the same time when necessary along with the Buprenex when T has been in a flare.

I'm not sure how helpful any of this is but if it is pancreatitis I wanted to share the info and let you know that I have used what I call a "cocktail" of drugs during a flare without any problems .

One final thought--Do you happen to have an internal medicine specialist involved vs. a regular vet? If not, I highly recommend getting one involved because it can make all the difference in the world with respect to diagnosis and treatment, including the best way to manage the use of various medications.

Many thoughts and prayers to you and YoYo

 

Thank you for explaining....almost sounds like Yoyo with the kidney disease....Yo had an ultrasound on 5/27 and they did find pyelonephritits and yet his pancreas looked normal but they did the pancreas test anyway and it came back at 4.3(not so high) but amylase is always high and I know that is not the best comparison to pancreatitis but his amylase is high over 4500 for years.
What is AB and is IM stand for Internal Medicine?

 

Thank you Wendy, I really appreciate all the info that you have given me

 

I can't thank you enough for all the information that you just shared with me....it seems that you are able to change T's dose at different times, please correct me if I am wrong, but I thought that you couldn't change dose amounts and that it was dangerous to do so.....please, I know nothing about prednisilone except what I have heard so I appreciate whatever you can share with me regarding prednisilone and how it is used

An internist did his ultrasound...I do not know of another internist in my area....and with covid19 I DO NOT want to drop him off anywhere because this is how this nightmare began for Yoyo.

Yesterday I started Yo out with 1/2 of a 5mg tablet am and pm. Today I gave him 1 5mg tablet am. The instructions are that the normal dose is 5mg 2x day. I thought perhaps he needed the full dose to help with the inflammation. But after reading what you wrote and you are so experienced, I don't know if I should be giving him 10mg/day. Any thoughts on this?

Please let me know if I am allowed to change the dose as needed. My vet isn't in the hospital until tomorrow for me to ask her some questions regarding prednisilone. You are only giving 5mg when T is in a flare and I am now starting to give 10 mg....sounds too strong to me, what do you think?

I did not know that pancreatitis can last as long as T has had it. I thought once treated, it is all cleared up. Shows how naive I really am.

Can you please tell me how long an episode/flare up last for Mr T. Yoyo got sick after having a cystocentesis on 5/20/20 which must of then caused a flare up with his pancreas. My doctor is not to hopeful for him and feels pred is his last hope. This does not make me feel the greatest to say the least

He was diagnosed back in 6/2019 with pancreatitis, test back in 6/2019 came back at 4.9 but he wasn't fasted and I was told that can effect the result, I was told to give him cerenia and buprenorphine but I chose to use SEB and it seemed to help with his mouth twitches. He has been taking SEB for 1 year but I recently stopped giving it because it interferes with giving other meds (aborption of the meds).

I do not know enough about testing and treating and I only know little pieces from here and there. Nothing conclusive as what you are telling me. I greatly appreciate everything and anything that you can tell me.

To sum up, Yo will be taking 5mg 2x day of prednisilone, he is also on zeniquin for whatever infection he got on 5/20/20. He started zeniquin on 5/31/20. Yo is also on felimazole for hyperthyroidism and has been taking this for over 3 years.
I have buprenorphine but I did not start it. I was given it back in 6/2019.

Again, I appreciate you and anything else that you can share or think of at this time. Please feel free to write what you think is happening and how Yo is being treated. Many Thanks!!

 

Do you know your vet is treating for pancreatitis? If so, the Prednisolone dosing your vet prescribed is not out of line. Keep in mind, up front, the focus is getting things under control and then the dose can always be adjusted. What you don't want to do is give a suboptimal dose that won't help because then symptoms can potentially worsen. It just so happened that when T had his first flare, which wasn't severe enough to require hospitalization, our regular vet started him on the 5mg and it was effective. When I sought additional diagnostics and an internal medicine opinion after getting the TAMU full panel GI lab back indicating pancreatitis, the prednisolone was not increased because he was responding well to the dose. After he was doing well and we were able to discontinue the subq fluids, cerenia (no buprenex required the first flare), we then made the attempt to reduce his Prednisolone to find a least effective dose &/or attempt to get to every other day dosing OR discontinue it. Unfortunately, as we reduced the dose, he began to become lethargic and eventually by Day 3 of discontinuation, he would vomit a small pile of spit and be in pain again. The time that a flare can last can vary. I have had times when Tomlin looked a little uncomfortable and I would increase the Prednisolone to 5 mgs for a few days and then he would be fine. When he is more significant flare, it has taken a few months to get him completely back to baseline where he is off all meds except for the Prednisolone and up and about doing his normal routine. Typically the worst part of the flare, when he doesn't want to eat and its lethargic, can be turned around within a few weeks if managed aggressively (aka IV fluids if needed OR if not requiring IV fluids, increase of the Prednisolone and use the anti nausea and pain meds along with sub q fluids depending on what is required).

Testing- A full TAMU GI panel is important. I am assuming they either did the full panel or just the Spec fPLI which is what is used to determine pancreatitis. With this particular test, fasting is preferred but NOT essential for accuracy of the test. I have done them fasting and non fasting and did not see significant differences even with tests repeated within weeks of each other.

With regard to acute vs chronic. There will be some cats that experience an acute episode that is so severe that they require hospitalization but then they recover, meds are slowly discontinued and they never have an issue again. Unfortunately, a fair amount of cats end up having chronic pancreatitis where either meds are discontinued and they are fine but then experience a flare again later or like my T require medication every day. The number of flares, how bad they are, what meds are required will differ with each cat. T had his first flare and then no additional issues or symptoms for a year and then he had another flare. He then did well with no additional issues for 4 years just taking Prednisolone and eating a low fat diet. Although fat is typically not an issue with cats with pancreatitis as it with dogs, it IS a very big issue for T. Again, trial and error to figure it out.

I will say that IF YoYo is experiencing a serious pancreatitis flare & is really not doing well, IV fluids are key and can really turn a cat with a more serious pancreatitis flare around much more quickly. I have done this and it helps significantly. Sometimes you can get away with doing 1 or 2 days of 12 hour IV fluids during the day at your vets office vs leaving the cat overnight. I know and completely understand and empathize with not wanting to take the cat into the vet given the experience you had, but IF there is someone you are able to trust and could help you with this that would be great. It is important that the pancreas is well perfused with blood and IV fluids are the mainstay of treatment to make sure this happens.

Buprenex is very helpful. Pain management is important. However, given that the prescription was given in the past I would want to run it by a specialist first. I say this because you want to make sure, as with any medication, that there is nothing going on clinically or with the labs that would make it not the best option for YoYo. Heart, thyroid health etc.. All of this comes into decision making regarding the use of any drug and the dose of a drug. Best to be safe!

Hang in there

 

AB = antibiotic. IM = Internal Medicine

Ollie is on daily pain management for p'titis. Always will be. She is a chronic kitty. When she goes into a flare up, her meds are increased. Then when flare subsides it back to regular doses (usually 24-48 hrs). You get to the point of seeing the signs of a flare up so with keeping supply of meds at home you can intervene quickly to prevent a serious flare that might require hospitalization.

Even if polynephritis, it can be painful for them to pee. Maybe see what happens with a lower dose every 12 hrs if you haven't start it yet. I'd rather Ollie be groggy and spacey for a day or two (though she never is) than in pain and miserable a lot longer.

 

Thank you again.....I have Yoyo on sub-Q fluids (lactate ringer) mixed with Complex B vitamins and he gets B12 injection once a week for about a month....He was in the hospital for IV drip on 5/26 for about 5 hours and then I returned him to the vet on 5/27 and he was supposed to have received IV fluidsall day but honestly I am not even sure if he did, they told me he did but that same day he had the ultrasound done as well. When he went home I asked for sub-Q fluids but I was told he did not need them!!
He has had full chemisty, CBC, T4, Urine culture and sensitivity(which came back negative ??) and the SPECfpl test which came back at 4.3 and he was fasted as I did not give insulin that day. They did full blood on 5/26 and 6/10. On 6/10 is when he started to have seizures when I got home from the vet. He was very weak. His blood wk is posted on his SS if you would like to look at it. His IDEXX SDMA has increased from 18 on 5/26 to 19 on 6/5/20....that concerns me....he used to be at 12 and 14 on the IDEXX SDMA. THe SS does not show this nor does it show his reticulocytes...I have all that if you want to know it.
His ultrasound report I can send to you as well, but it shows NORMAL pancreas and possible pyelonephritis.

Is Buprenex the same as liquid formula buprenorphine(bupe)? Vet said that I could give RX from last year but then when he started to have seizures I did not give the bupe. But now he has started pred on yesterday, 1/2 tab(2.5mg) 2x day, but today is the first normal dose of 5 mg 2x day.
He started fluids 3 days ago.
He urinates a large quantity and that makes him weaker, he has been urinating large quantities for weeks now and I tell the vet with no response back. I know the fluids now will make him urinate more too, but he has been urinating excessively way before the fluids ( I see his peepee come out).....he has started to drink and drink and doesn't want to stop. But eventually he does stop drinking.
He sleeps and sleeps. He will move locations, yesterday he surprisingly went upstairs, he hasn't gone up in over a week!
He will not eat. He shuts his jaws tight on me. But I finger feed him and when I get his mouth open he does swallow the food and he doesn't look sick eating it. He doesn't like when I add chicken liver to it but I do it for his anemia. I also put steak in his food and hard boiled eggs. He doesn't mind the hard boiled egg as it is all dissolved and mixed in his canned pure' food. He also gets pumpkin for constipation and he has been fine with normal stools. He likes pumpkin on a good day, when he feels good!

I gave him cerenia in the beginning, I don't think it did much, he still won't eat. He only vomited once about 2 weeks ago.
I tried ondansetron but again I only gave it once and I didn't see any relief.

I still have cerrenia and ondansetron to give, along with bupe and the pred. And he takes zeniquin 25 mg once a day. And he takes felimazole 2.5mg 2x day for hyperthyroidism.

On 5/26 he got an injection of Convenia, which I read can cause anemia too! That is why I waited to give zeniquin until I believe it was 5/31 because I din't want to mix the convenia shot with zeniquin. I aksed for zeniquin because he got very sick back in 4/2018 with a high fever and no one knew the cause. He had convenia then too and a snap fpl test was done back in 2018 and it was normal. But whatever he had back in 2018 cleared up with zeniquin.

Also 12/2017 Yoyo had his left front leg and shoulder removed due to cancer. After the surgery where hi did not lose any extra blood, he had to have a transfusion as his HCT went low, I think under 14.

Also as a baby when he was neutered he would not heal. His incision would not scab and he got anemic. Special blood work was run, a long funny name I can't think of, and all came back negative. Further testing rrquired that I send Yoyo to Texas. That was not happening!!

So Yoyo has a history of anemia that is unknown cause.

Please let me know if I can give you anymore info. You are GREAT and I appreciate all of your time and help. Many thanks!!

 

Thank you....now I understand why I see you writing about meds and I didn't understand the insulin dosage.

 

It's the easiest way for me to keep track. She gets bupre at 6 a.m. with her shot then every 8 hrs. I put the dose there so I know what she got since it can change. She gets 0.15 ml now maintenance (concentration changed and this new bupre is stronger, but still same mg as when on 0.2 ml) Anything higher is for flare up. I use phone to enter into ss. Scrolling to remark section is hard and to small so I put it in regular cells.

 

Sorry to ask you another question......but.....I looked up TAMU full panel GI lab, I never heard of it before. I believe it is extensive GI blood wk? Am I correct?
My vet has never suggested such a blood wk. Is this a common blood wk test? What else shows up on the blood wk?

 

Poor guy! It is not uncommon for them to sleep a lot in a flare. If the pain is bad enough it will even keep them from sleeping. Pain also results in them not wanting to move much let alone walk around the house. When T has been in a flare, I keep a litter box close by so he doesn’t have to go too far. His most recent flare required both Cerenia and Zofran at first to keep his nausea under control. They work differently so they can be given together and often work well when given together vs one or the other. In addition, keeping the pain under control is important or they associate eating with pain (and also with nausea) and then become averse to eating.
Keep in mind that the drugs probably seemed like they didn’t help because pain sounds like it still is an issue and also, most likely, there is food aversion there because the nausea and pain have been there before you started trying to treat it with Cerenia or Zofran. Only after you get the nausea and pain in control and they start eating and don’t feel the same way will they be interested in food again. At times I have to change the food in the beginning to something that smells different than the food they are associating nausea and/or pain to. This is key because you will notice if you make the mistake of discontinuing meds too fast and they get hit with nausea or pain, you may have to take a few steps back to get them eating again. It’s very important that those symptoms are kept in check. ECID with respect to how fast they will develop the aversion. My T develops it quickly so we are VERY slow and steady with discontinuing meds as he improves. I would also ask about medication options for anemia vs egg and steak when he is feeling so ill. Think easily digested when in a flare and also small meals . I even make sure to keep control of the small meals when he starts to feel better so that he doesn’t eat too much and have a bad experience when he is finally feeling better!

 

It is an extensive GI panel of blood work which will include the Spec fPLI which is the gold standard for diagnosis of pancreatitis and will let you know the level of specific pancreatic lipase elevation if there is any. It also includes TLI which will determine if there is any Exocrine Pancreatic Insufficiency (EPI) as well as levels for B12 and Folate. All important if there is any possibility of a GI issue. The specific levels can also help with providing info that may lead the specialist to other conditions that may be causing slight elevations or low levels in the labs.