Gallstones, Pancreatitis, triaditis...anyone have experience?

kittymonsters

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My big guy, Stomper, has been sick for a week. Over the last two years he has developed episodes of vomiting followed by anorexia. This has always resolved with fluid therapy, cyproheptadine and pain meds for a couple days. His last episode was December 07. No specific diagnosis was ever given in the past.

Last Thursday another episode started and we still cannot get it turned around. He has had 3 x rays, an enema for extreme constipation, Sub Q and now IV fluids. When the enema didn't return his appetite and the post enema x-ray showed a mineral opacity near his liver an ultrasound was done. This showed a gallstone ( vet said very rare in cats) and an inflamed pancreas. Blood work has ALT levels 2x upper end of normal range, but ALP, AST and bilirubin are normal.

The special pancreatitis blood test ( I can't remember the name right now) was sent off this morning, but won't be back for 5-10 days. Treatment for pancreatitis was started with steroids. Actigall for the gallstone has been ordered and will be there tomorrow.

Tonight Stomper had to be tube fed as he has refused all food since Wednesday evening. I am extremely worried about the vet having waited 48 hours to start force feeding having already lost one kitty to hepatic lipidosis.

If Stomper hasn't eaten by morning the thoughts are for surgical intervention to remove the gallstone and examine the liver and pancreas. I am worried about this as it isn't even clear that the gallstone is actually blocking the bile duct or causing a problem. Since gallstones are so rare in cats there is no data on whether the disease process is the same as in dogs and humans. I have found information on pancreatitis in cats and it is distinctly different than dogs and humans.

I honestly cannot afford a surgery that is likely to kill him. This month already I have spend $600 in vet bills and this does not count the last three days of hospitalization and testing. I have this estimated at about $1000 and counting. However if the odds are he is going to recover and live a happy life then I will find the money somewhere, period.

More importantly though, I don't want Stomper to suffer needlessly. I have gone that route before and watched Lily and Fletcher die prolonged painful deaths due to the vets idea there was a very minor chance of survival. It would have been far kinder to them if I had followed my instincts and had they PTS. I don't want to put Stomper through that type of suffering too.

The biggest problem is I can't find any good information on gallstones and chronic pancreatitis and possible IBD all at the same time in cats. I don't have any idea of what the prognosis is and the vet doesn't either.

Has anyone here ever dealt with this or know anyone that has? I did a forum search on gallstones and only two posts came up, one the cat died within 24 hours of surgery. The other never had a final outcome.

Any thoughts would be appreciated even if you don't have experience. If Stomper was your kitty what would you be inclined to do and why?
 

aswient

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I'm so sorry for all of Stompers problems, and I'm sorry I don't have any experience with this. I'm sure someone will come along and be able to offer advise.

Prayers for Stomper and you.
 

optionken

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If your cat does have it, the main thing is diet. I know the vet will want to prescribe prednisone which can cause other problems but if you work and get the diet right then it may not be needed. Dry foods are NOT good for any cats and especially for this disease and you do not want to feed the crap the vet sells.
Many cats do well on a quality low fat diet. You want to keep the fat content under 35%-40% of calories or 4% fat if you use the labels instead of the link for a food chart I will give you. The problem with lowering fat is that usually raises the carb levels in the food. To combat this you can add some chicken breast to the diet which will lower the fat content. You want high quality food like merrick if possible Also, get some acidoupholous from a health food store and sprinkle a bit over the food. If you really want to do what is best then a raw food diet that you make is best for a pancreatis cats. I do not do this but many people I know do that have cats with pancreatis and have had alot of success. There is work and an initial investment as you would have to buy a grinder. If interested in this, I will send you a link on how to prepare it
Next thing
If you get this diagnosed properly and you are sure about it, you will want to learn about pancreatic enzymes, get b-12 shots and also learn how to do sub-q fluids which can be done at home. Also keep some pepcid ac in the house for flareups and upset stomachs. You can give 1/4 tab of it 2x a day or the vet can sell you injectable pepcid,
Don't mean to scare you with all of this. Realize that with the proper diet, it is possible to never see pancreatic fllareups again
Link to the food charts
http://www.geocities.com/jmpeerson/canfood.html
 
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kittymonsters

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Aswient, Thank you so much for your reply and prayers. They are greatly appreciated.

OptionKen, Thank you as well for the excellent information. I switched to homemade/raw feeding when the recalls started and all seven of my kitties have been transitioned for almost two years now. I jumped right in and bought the grinder and everything. I swear I spend more time preparing their food than mine.

There was a recent switch however, and it was to purposely add more fat to the recipe for my CRF kitty. This "tweak" was done by Dr. Pierson who does all the raw food stuff. I paid for a consultation and my vet sent all Zoe's bloodwork for review. I do all the fluids already too, so luckily I am a little ahead of the learning curve on some of this.

At the time it was though this diet would be fine for everyone, well we didn't realize that Stomper was likely a chronic pancreatitis kitty at the time. So I am going to make separate batches now and just make the higher fat formula for Zoe.

On to some better news. I took the good advice that was Pm'ed to me by a wonderful member here last night. This morning when the vet called and Stomper was still not eating, I followed my gut and asked to bring him home. Since they had discontinued IV fluids, everything else they were doing I can do at home. Plus, Stomper would be much more comfortable here. When I got him home, I decided to just pretend everything was normal and started getting their lunch time meal ready. To my surprise and delight instead of going and hiding, Stomper started his usual begging. He ate a full helping of lunch ( which today consisted of 1/2 can of NB Ultra formula). all by himself, no coaxing from me needed.


He is on several meds: Prednisolone, two week taper, cyproheptatine 2x daily if he doesn't keep eating, and 1/4 tablet Actigall (this stuff is expensive! $18 for four pills) daily. Hopefully this will flush the gallstone. I always keep Pepcid AC on hand per the vets advice for Zoe. I am hoping Stomper doesn't start vomiting again though.

The fPLI test should come back next week to confirm or rule out the pancreatitis dx.

This is really an overwhelming illness (es) to deal with. The CRF learning curve was bad enough. I am so grateful to the wonderful people who have "been there and done that" and are so willing to help newbies to that illness.

That is the hardest thing about this, so little is concrete information for long term management or even diagnosis for that matter.
 

optionken

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Hi
Glad you know dr Lisa! She is great.We have communicated through the feline diabetes board.
I am so sorry you are going through all of this. it is obvious you are doing everything possible.
A few other things
Have you tried a novel meat like vennison or rabbit?
If triaditis happens to be ruled out, have you thought that maybe this can be some sort of infection they haven't found? Hve serious antibiotics (not clavamox) been considered?
Just trying to throw out ideas. You have all my best thought and vibes and I hope you get a good answer soon.
 
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kittymonsters

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Originally Posted by optionken

Hi
Glad you know dr Lisa! She is great.We have communicated through the feline diabetes board.
I am so sorry you are going through all of this. it is obvious you are doing everything possible.
A few other things
Have you tried a novel meat like vennison or rabbit?
If triaditis happens to be ruled out, have you thought that maybe this can be some sort of infection they haven't found? Hve serious antibiotics (not clavamox) been considered?
Just trying to throw out ideas. You have all my best thought and vibes and I hope you get a good answer soon.
Thank you for your questions, ideas and vibes. We can use all of them! I am sorry you have had to go through all of this with your diabetic kitty. It is so stressful when they get something that is difficult to control.

I do have access to grass fed/free range beef, buffalo, elk, venison, lamb and organically raised pork. This is about the only advantage to living in the middle of nowhere. The only thing that is prevalent around here are ranches.

I don't know if he would eat rabbit, but that might be good because it is very low in fat. I know the Buffalo from the farm is tested at 97% lean. However, I have tried beef before and my conclusion is...."Beef, it's what they barf". Ugh none of them tolerated it, though they all love it.

Thus far neither of the vets have suggested any antibiotics. I don't know if the hospital vet talked to his regular vet. I am supposed to call the hospital vet tomorrow.

As of now Stomper is stable, but certainly not himself. He is eating on his own (knock on wood). I made him a special batch of turkey just for him. He is liking it and not vomiting. However he does seem to get droopy/not feeling well after he eats. He just doesn't look right. He doesn't go and hide now though, so that is an improvement. I know he is doing better than he was two days ago, but still not "normal".

He is on day four of his prednolisone and only had his second does of Actigall tonight.

I will update again after I talk to the vet. If nothing else, maybe this thread will help someone else in the future.
 
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kittymonsters

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Thanks Mews2much.

Today there were some minor improvements. Stomper actually left the bedroom and came out to be with everyone. Sleeping in his usual spot on the couch.

He is still eating on his own and was a little enthusiastic today instead of just picking. However, a while after he eats he seems to get lethargic and like he has a painful belly.

I talked to his regular vet and the hospital vet today. As long as he is stable we are waiting on the fPLI test. Stomper's regular vet ( new in the last year) really thinks he does have underlying chronic pancreatitis and this has been going on long term. She is hoping that we can get him stabilized so he never has another crash.

Both Vets want to give the Actigall a chance with the gallstone since it didn't appear to be blocking the duct, just slowing things up. If all goes well they want to do another ultrasound in a couple weeks to re check the status of the stone. Hopefully it will be flushed and gone.

For now it is wait and see, hoping for improvement each day.
 
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kittymonsters

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Update for future references.

Stompers fPLI test came back a strong postive, 36 ug/L Right now the official diagnosis is triaditis.

For those that want to understand this test it is run at Texas A&M university.
http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml

"
> 36.0 µg/L Severely increased serum fPLI concentration is associated with pancreatitis. Patient should be evaluated for risk factors and concurrent conditions. Supportive and symptomatic care is indicated dependant on the condition of the patient. Serum fPLI should be monitored to evaluate progression of disease. "

On Saturday Stomper perked up and was really back to normal, headbutting and rolling over for belly rubs.

He is on prednolisone still, will start the every other day taper tomorrow. He is still on the Actigall, we are trying to find a less expensive source. It is looking like I will need to weigh it out myself ( thankfully I have a chemistry degree and a microgram scale). The generic ursodiol only comes in a powdered capsule form in human dosages. The compounding pharmacies want about $2 a pill to make it into a smaller dose. So for anyone else in this position, purchasing a $50 digital microgram scale and getting the human dose pills and weighing out oneself is going to be the most cost effective method for long term care. For those nervous about weighing properly the vet or phamacist should have no problems teaching how to use the scale properly.

Stomper will go in for another abdominal ultrasound in mid August to re-evaluate the gallstone.

No one has mentioned putting him on long term antibiotic therapy, although that is the treatment of choice for cholangiohepatitis, part of triaditis. I will call his regular vet tomorrow ( she is only in the clinic one day a week) and ask her about it.

I still don't know if the gallstone itself could set off pancreatitis and cholangiohepatitis or if bacterial migration from the intestines due to IBD is necessary. Hmmmmmmmmmm.


All in all, anyone who has a kitty that goes through spurts of not eating and not feeling well for 2-3 days for what seems like no reason please ask the vet to check for chronic pancreatitis. This is Stomper's 6th time of having an episode like this. This is the first time it has lasted 2 weeks, but never has the vet said anything other than either it was constipation or it was "a virus". If I had not changed vets last year, Stomper would still not be diagnosed.

this is the big guy on Friday...starting to feel a little better Meowmy...
 
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kittymonsters

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October 23, 2008 update for future reference. Hopefully no one will ever need to read this thread because they are going through the same thing, but it will be here just in case.

Since July Stomper has continued with on and off bouts of vomiting and anorexia. Treatment with prednisolone, Denamarin, Actigall and Metronidozole seemed to work short term, but about every three weeks or so a new round of illness would begin.

Stomper saw the internal medicine specialist two weeks ago and she repeated his x-rays and ultrasound. He has a 14 mm gallstone which can been seen as the bright area in the lower left of the x-ray right over his liver and just back from his rib cage


The gallstone is right ^ there, small bright area. His intestines are all dark because he had just had an enema, poor guy.

This next picture is the ultrasound showing the gallstone inside the gallbladder.



Because of the rarity of gallstones in cats the internist was not certain that the gallstone was actually causing a problem or was an incidental finding. The plan was to try treatment for IBD and food allergies firstbecaue the surgical risks are so high and it is not clear it would help at all. They added metronidazole to the treatment and put Stomper on IVD/Royal Canin Duck and Green Pea limited ingredient formula.

I was leary of the diet since Stomper is already on a homemade limited ingredient, no grain diet. The vet was concerned though that he had possibly developed a sensitivity to chicken.

Despite this treatment Stomper has had on and off bouts of vomiting and anorexia the past two weeks. This culminated two days ago with the development of projectile vomiting. Stomper actually started spewing vomit while he was sleeping.

He was taken to the emergency specialty clinic and has been stabilized. He has pancreatitis and cholangiohepatitis based on bloodwork and Ultrasound. Also there is an area of thickening of the duodenum on US.

The four vets that have examined him are still not sure if the gallstone is the causative agent or not. Since the other treatments are not working they are going ahead with the surgery tomorrow because
Stomper is going to die if things don't get under control. They will attempt a cholesystotomy but may have to do a complete cholesystectomy. He will also have biopsies of his intestine, liver and pancreas.

Risks right now include hepatic lipidosis, bile peritonitis, and development of DIC. He will not come home from the hospital for at least four days and even then he will most likely still have a feeding tube.

To be honest I have no idea if I am doing the right thing in having the surgery done. It is extremely expensive and will completely wipe out all my savings. I don't know if I am going to cause him more suffering. However I couldn't bring myself to euthanize him if there was a chance he could be saved. At the same time I couldn't do nothing because his quality of live is becoming poorer and poorer. It was try the surgery or death at this point.
 
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kittymonsters

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Update November 10, 2008.

Well Stomper's biopsy results came back:

No bacteria or infective processes or lymphoma! ...yeah!

lymphocytic/plasmacytic cholangitis
lymphocytic/plasmacytic cholangiohepatitis
lymphocytic/plasmacytic enteritis

Long story short....feline triaditis not cause by bacterial infection.

No one seems to have an answer if the gallstones and sludge were making him worst, but based on his recovery I think they were. He has not had a vomiting or refusal to eat episode since his surgery.

Fingers crossed that he stays improved. He is to stay on his grain free homemade diet and the vet stressed he is to get NO other kind of food, ever. This diet is designed for IBD cats.

For the long term he is on a low dose of Famotadine, Denamarin and the Actigall (Urso)
Again for anyone who has a cat that needs to be on Actigall long term, get the capsules and a milligram scale (~$50-100 U.S.) It will save you lots of money in the long run. Actigall is outrageously expensive and the generic only comes in powder not pill form.

For now we are holding off on the steroids, unless he crashes again. Tomorrow he goes for a check up and blood tests for liver function.
 
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kittymonsters

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thanks Mews.

They didn't want to put him back on the metronidozole because he didn't have any bacteria showing up. I don't know if he has an acute episode again if he will have to go back on it or not. For now I am really hoping we can keep him under control with diet and the few meds he is on.
 

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Iam sooooooooooo happy that he is doing well now. Wow, how many surgeries has he had for this? This must be physically and emotionally exahsting for you and him.

So
to both of you. & vibes for a speedy and uneventful recovery.

Please keep us updated, I am suprised that such a emotional thread has such a lack of responses.

Hang in there.
 

strange_wings

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Originally Posted by kittymonsters

Again for anyone who has a cat that needs to be on Actigall long term, get the capsules and a milligram scale (~$50-100 U.S.) It will save you lots of money in the long run. Actigall is outrageously expensive and the generic only comes in powder not pill form.
Maybe it's just that they don't make it for veterinary use in pill form? Because I took a generic years ago.. nasty little blue pills that eventually started causing me to have nausea and vomiting - so I had to quite taking it.
 
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kittymonsters

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Originally Posted by KatKisses

Iam sooooooooooo happy that he is doing well now. Wow, how many surgeries has he had for this? This must be physically and emotionally exahsting for you and him.

So
to both of you. & vibes for a speedy and uneventful recovery.

Please keep us updated, I am suprised that such a emotional thread has such a lack of responses.

Hang in there.
Thank you so much KatKisses. I got some PM and lots of posts for vibes on Stomper's surgery thread. I think this one is hard because there is so very little information out there on gallstones in cats.

Originally Posted by strange_wings

Maybe it's just that they don't make it for veterinary use in pill form? Because I took a generic years ago.. nasty little blue pills that eventually started causing me to have nausea and vomiting - so I had to quite taking it.
I am glad to have your impu on the Actigall. I wonder if the Urso is causing Stomper some nausea? I can't find the generic in a pill form anywhere. I am getting the Urso from the people pharmacy, it comes in a 300 mg capsule that I measure the powder out into smaller capsules. Stomper gets 60mg a day.

Originally Posted by Bella713

How is Stomper doing?
Bella Stomper says those big fluffy boys of yours, Sev and Mario, on over to play



Update for 11/14/08

This week has been up and down a little bit. On Tues Stomper decided that he did not want lunch. This continued on Wed, and Thursday as well as a little bit today. He was started back on his Prozac on Sunday as he was feeling well enough to start spraying again...yes he is a cutie but he is also a bad boy
. The vet and I are hoping it is the Prozac that is making him not so hungry at lunch so that was stopped. Will know in by tomorrw if this is the case. Other than not wanting his lunch he is doing really well. Back to wanting lots of attention and peeling out on the wood floor when playing.

He had to see the vet on Tues as well for a check up. His check up was good, he didn't have any tenderness in his belly and his incision looks great. It is almost invisible now.

His blood work came back yesterday and everything is normal WHOO!!!! Even his liver function tests which haven't been in the normal range for almost a year now.

The only slighty worrisome thing is his hematocrit (HCT) was a bit on the low side at 30.5. Not sure if this is something we need to be concerned about. My regular vet put a call in to the surgeon just to be sure.

Stomper's weight is also down by about a pound. He was 12 pds pre-surgery at my vets and has been that weight consistently for a year, and 11.7 at the surgeon's. Tuesday he was down to 10.6 pounds. Have to keep an eye on that as well.

He is sitting here looking at me as I am typing this.
It is dinner time and he is trying to make sure I don't forget that.
 

pami

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I am so glad your sweetie has healed, but Im so sorry he has been having appetite issues, that poor baby.

I have heard that Busbar and cats and very little side effects. you might want to discuss that with your Dr instead of the Prozac.
 
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kittymonsters

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Update 11/30/08


Stomper is doing wonderful! (knock on wood). I still get nervous everytime I say that. He has become a very playful kitty again. He is so big and fluffy that he looks hilarious running around chirping and sliding across the wood floors.

I stopped his Prozac and his appetite came back with a vengence. Now everytime I go in the kitchen he is dancing around my feet thinking it is food time for him too.

Dr. A and Dr. C both spoke to the internal medicine specialist about Stomper's low HCT. Going through his bloodwork it was 36 pre surgery and 15 the day after surgery. It appears he had a pretty significant bleed during the operation, but not enough to need a transfusion. (Note: if you are considering this surgery for your kitty make sure you have a specialty surgeon. This is a complicated surgery and I wouldn't let just any vet do it.)

He gets his blood checked again in another two weeks. If everything is normal he will get it checked again in another two months. If that is normal he gets to be considered to be a "normal" cat again!

What I really want everyone to take away from this thread is that if your cat is diagnosed with gallstone/sludgy gallbladder it very well could be causing IBD/Pancreatitis/Hepatitis/ symptoms.

Or if your cat has Pancreatitis or triaditis make sure to get an ultrasound of the gallbladder to check for sludge/stones.

Dr. S. the internal medicine vet, apologized for not doing Stomper's surgery back in August like his regular vet, Dr. A, wanted. Dr. A was going on gut instinct that it was the gallbladder causing his problems even though the literature says cats don't get gallbadder disease. Dr. A. really saved Stomper's life.

This was a learning experience for all involved, even the specialists.
 
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