my 16y.o. male cat has pancreatitis...

this is the second time my cat is dealing with pancreatitis in a 6 month period....same symptoms both times....my cat started having bad diarrhea for 3 days and stopped eating and was drinking water like every 10 minutes...so this time when he stopped eating for 2 days i knew that its probably pancreatitis again.  he urinates larger amounts but he's not making extra trips to the litterbox than usual.   and he hasn't been vomiting at all...   went to the vet and they did a spec fpl test and his result was 9.8 ug/l.  the first time and this time the spec fpl test result was 6.8 ug/l...

the vet prescribed him antibiotics, some pepcid AC and that prescription canned food "I.D.".     well my cat wont touch the prescription food so i've been giving him fancy feast...he seems to be feeling better and his poops are close to being completely solid.  but i'm not sure about the pepcid since he isn't vomiting...should i still give it to him?   his kidney values are still in the normal range but at the very high normal side... this treatment was the same as last time but i'm wondering if he ever really recovered from it the first time.. is there any food other than the i.d.  that i could feed him.  i don't think fancy feast is ideal so if anyone knows of any other brands that would be okay for pancreatitis?

here are his lab results:

SENIOR SCREEN w/ SPEC fPL : CHEM 25

Test Result Reference Range Low Normal High
ALK. PHOSPHATASE 27 0 - 62 U/L
ALT (SGPT) 50 28 - 100 U/L
AST (SGOT) 23 5 - 55 U/L
CK 371 64 - 440 U/L
GGT 1 0 - 6 U/L
ALBUMIN 3.6 2.3 - 3.9 g/dL
TOTAL PROTEIN 8.1 5.9 - 8.5 g/dL
GLOBULIN 4.5 3.0 - 5.6 g/dL
TOTAL BILIRUBIN 0.1 0.0 - 0.4 mg/dL
DIRECT BILIRUBIN 0.1 0.0 - 0.2 mg/dL
BUN 34 15 - 34 mg/dL
CREATININE 2.2 0.8 - 2.3 mg/dL

CHOLESTEROL 225 82 - 218 mg/dL HIGH

GLUCOSE 134 70 - 150 mg/dL
CALCIUM 9.6 8.2 - 11.8 mg/dL
PHOSPHORUS 5.0 3.0 - 7.0 mg/dL

TCO2

6

13 - 25 mEq/L LOW

(BICARBONATE)

CHLORIDE 118 111 - 125 mEq/L
POTASSIUM 4.7 3.9 - 5.3 mEq/L
SODIUM 154 147 - 156 mEq/L
A/G RATIO 0.8 0.4 - 0.8

B/C RATIO 15.5

INDIRECT BILIRUBIN 0.0 0 - 0.3 mg/dL

Page 1 of 4

NA/K RATIO 33
HEMOLYSIS INDEX N 1
LIPEMIA INDEX N 2

ANION GAP 35 13 - 27 mEq/L HIGH

Comments:

1. Index of N,+,++ exhibits no significant effect on chemistry values.
2. Index of N,+,++ exhibits no significant effect on chemistry values.
SENIOR SCREEN w/ SPEC fPL : CBC COMPREHENSIVE

Test Result Reference Range Low Normal High
WBC 6.9 4.2 - 15.6 K/uL
RBC 7.17 6.0 - 10.0 M/uL
HGB 10.8 9.5 - 15 g/dL
HCT 37.1 29 - 45 %
MCV 52 41 - 58 fL
MCH 15.1 11.0 - 17.5 pg
MCHC 29.1 29 - 36 g/dL
% RETICULOCYTE 0.9 %

RETICULOCYTE 65 3 - 50 K/uL HIGH
RETICULOCYTE In nonanemic cats, a reticulocyte count of greater than 50 K/uL of
COMMENT blood may be a transient physiologic response or evidence of bone
marrow response to an increased peripheral demand. A persistent
reticulocyte count >50 K/uL may indicate occult blood loss,
underlying
hemolytic disease or disorder that causes an absolute
erythrocytosis.
Serial monitoring of the erythrogram and reticulocyte count may
help
determine the significance of this finding.
The following chart can be used as a guideline to determine the
degree
of regenerative response.
Degree of bone marrow response (K/uL):
Mild 50-75
Moderate 75-175
Marked >175
Please note: For information about our new reticulocyte reporting,
please see the Diagnostic Update on Vetconnect.com or call the
internal medicine consulting team at 1-888-433-9987, option 4,
option
2.
NEUTROPHIL SEG 83.5 35 - 75 % HIGH

LYMPHOCYTES 9.4 20 - 55 % LOW
MONOCYTES 3.6 1 - 4 %
EOSINOPHIL 3.5 2 - 12 %
BASOPHIL 0.0 0 - 1 %
AUTO PLATELET 355 170 - 600 K/uL
POLYCHROMASIA SLIGHT
REMARKS SLIDE REVIEWED MICROSCOPICALLY.

Page 2 of 4

ABSOLUTE

5762 2500 - 12500 /uL

NEUTROPHIL SEG

ABSOLUTE
LYMPHOCYTE
649 1500 - 7000 /uL LOW
ABSOLUTE
MONOCYTE
ABSOLUTE
EOSINOPHIL
ABSOLUTE
BASOPHIL
248
242
0
0 - 850 /uL
0 - 1500 /uL
0 - 100 /uL
SENIOR SCREEN w/ SPEC fPL : T4

Test Result Reference Range Low Normal High
T4 1.8 1 0.8 - 4.7 ug/dL

Comments:

1. Interpretive ranges:
<0.8 Subnormal
0.8-4.7 Normal
2.3-4.7 Grey zone in old or symptomatic cats
>4.7 Consistent with hyperthyroidism
Cats with subnormal T4 values are almost exclusively euthyroid sick or
overtreated for their hyperthyroidism. Older cats with consistent
clinical signs and T4 values in the grey zone may have early
hyperthyroidism or a concurrent non-thyroidal illness. Hyperthyroidism
may be confirmed in these cats by adding on a free T4 or by performing
a T3 suppression test. Following treatment with methimazole, T4 values
will generally fall within the lower end of the reference range

(0.8 - 2.3).
SENIOR SCREEN w/ SPEC fPL : URINALYSIS

Test Result Reference Range Low Normal High
COLLECTION
METHOD
FREE-CATCH
COLOR YELLOW
CLARITY HAZY
SPECIFIC GRAVITY 1.017
GLUCOSE NEGATIVE
BILIRUBIN NEGATIVE

KETONES NEGATIVE
BLOOD TRACE HIGH
PH 6.0

PROTEIN NEGATIVE

WBC 2-5 0 - 5 HPF
RBC 0-2 0 - 5 HPF
BACTERIA RARE (<8/HPF) HPF
EPI CELL RARE (0-1) HPF
MUCUS NONE SEEN
CASTS NONE SEEN HPF
CRYSTALS NONE SEEN HPF

Page 3 of 4

OTHER AMORPHOUS DEBRIS
UROBILINOGEN NORMAL

SENIOR SCREEN w/ SPEC fPL : SPEC fPL

Test Result Reference Range Low Normal High
SPEC fPL
6.8 1 ug/L

Comments:

1.
< or = 3.5 ug/L - Serum Spec fPL concentration is in the normal range.
It is unlikely that the cat has pancreatitis.
Investigate for other diseases that could cause
observed clinical signs.

3.6 - 5.3 ug/L
- Serum Spec fPL concentration is increased. The cat
may have pancreatitis and Spec fPL should be
reevaluated in two weeks if clinical signs persist.
Investigate for other diseases that could cause
observed clinical signs.
> or = 5.4 ug/L - Serum Spec fPL concentration is consistent with
pancreatitis. The cat most likely has pancreatitis.
Consider investigating for risk factors and
concurrent diseases (e.g. IBD, Cholangitis,
Hepatic Lipidosis, Diabetes Mellitus). Periodic
monitoring of Spec fPL may help assess response to
therapy.

Page 4 of 4

My understanding is that pancreatitis can be chronic.  Granted, I have never had a cat with this issue, so don't know much about it, only what I have read.   But from what I have read, cats are normally in pain, and dehydrated, so I am kind of surprised that they didn't give him fluids and pain medication while at the Vet's office.

In my opinion,if he is not throwing up, why give him the Pepcid, and if he won't eat the I/D, then feed him anything he will eat.  With Pancreatitis, many smaller meals are better than nothing.  Here is a website that is invaluable to many of our members.  It is mainly for cats with kidney disease, but there is a section regarding pancreatitis:

http://www.felinecrf.org/pancreatitis.htm

for your old guy.  Hope you can get this under control.

they did give him fluids and pain meds at the vets office when i took him in... sorry i forgot to include that with my earlier post...  he is eating and drinking water again and has almost solid poops but they are almost black in color and he only goes once or twice a day now...no more diarhhea though.   the first time he had pancreatitis they also gave me buprenephrine to give him for pain...enough for a week.   i did it for a couple days but he wouldn't eat while on that stuff. so i stopped.

thanks for the link...will check it out.  i've been a member of that crf group before 6 years ago when my cat had a bout with acute renal failure(he's been through it).. they are very helpful and a great supportive group of people! 

Pancreatitis can leave a kitty very, very nauseous. As long as he's not lip smacking then he's okay but if he starts to do that, I would go back to giving Pepcid. And yes, pancreatitis can be chronic. If you can get any grain free food, that's best as it's low carb and low fat. 

just recently found out he also has mast cell tumors on his liver and spleen along with pancreatitis again at a very high spec fpl test result was 14.1.  low rbc and white bc,  but kidneys are in normal range.. he's 17 years old and my options are to put him down, or to keep him as comfortable as possible at home with pain meds and hopefully he will eat...or surgery which would be too dangerous for him and the tumors will grow back. so I decided to take him home and comfort him....its been 2 days so far and he is taking buprenephrine and prednisolone and generic Pepcid (famotidine). now he is so drugged out and spaced out that I can't really tell how he feels... hes been barely eating about half a can of fancy feast a day.  he drinks plenty of water.  he has trouble walking...he has to stop and take a rest every 6 to 10 feet when he goes to the litter box.   i'm hoping the steroids will help him with the pancreatitis and buy him a little more time... are there any other treatments I can give him? should he be on antibiotics?  any tips or suggestions would be greatly appreciated. thanks!

Poor old fellow.
He does need to get more nutrition than that. There are appetite stimulants that might be helpful . also anti nausea med like Cerenia which was very helpful to my cat . You may need to syringe feed . I just don't want him to get hepatic lipidosis on top of what is going on already with his liver already compromised.

I have given sub q fluids at home during a bad pancreatitis flare-up, to help flush out the inflammation.

Can you set up another litterbox closer to his bed? I would leave the old one in case he prefers that location. but show him one that is closer and easier for him to get to.

There is a feline pancreatitis group that you might find very helpful. http://pets.groups.yahoo.com/group/Feline_Pancreatitis_Support/

Here is an excerpt from an old post about chronic pancreatitis on the Feline Diabetes Message Board ( from Jojo, a very experienced vet tech and caregiver of diabetic cats): It is a good summary of different kinds of treatment used :

"possible tools your vet might have you use:
~SQ fluids
~ pain meds
~ anti-nausea meds ( pepcid falls in this category)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed
~ +/- appetite stimulants if needed (and if liver not involved, some of these are contraindicated with liver issues)
can all be used to help the cat through the flare up. your vet can work up a treatment plan for managing your cat's CP flare up attacks.
the veterinary community is still undecided on the issue of fat content of food and whether or not it is something to be considered in feline CP. it is very much an issue in human or canine CP, however felines are very unique in how they utilize the fats (and protein) in their diets. anecdotally, some owners find that lowering the fat content (to about 35% or less) of their CP diabetic cat's diet even though it means they have to raise the carbs helps. ECID, you would have to experiment on that yourself. just a reminder on the topic of food..as a CP flare up begins cats will eat less in the days leading up to it and often not eat at all when the attack is in full force, know that it does not take many days of reduced calorie intake to make hepatic lipadosis possibly rear its ugly head, especially in a liver already compromised. "


Here is a link to an article about treatment http://www.idexx.com/pubwebresource...ng-pancreatitis-and-concurrent-conditions.pdf

I hope you can get him better and he will have a while longer with you of feeling pretty well and happy. It is hard to know when it's time to let them go, and it depends on the individual animal.

thanks for your link and suggestions!!  much appreciated ,...after reading your response i set up another litterbox closer to him...and he used it right away... he uses both...but the new one he mostly just lays in it for awhile.  then he paces back and forth and gets back in bed..  I've been up all night tending to his needs, worrying about him and crying like a girl ...lol.  he was eating yesterday and the night before but its been almost 12 hours since he's eaten anything of any significance and very little water too.  i'm gonna get some subq's from vet this morning and i'll ask about antibiotics too.   the vet doesn't seem to be interested in recovery he expects me to keep him comfortable until its time to put him down...  I know that i'll know when the time comes and I just don't feel like its that time yet.

can you see a different vet? what about pain meds like buprenex?

sorry, didn't see the previous post that he already had it. So sorry this is happening. 

he also seems to be having a lot of trouble sleeping... almost falls asleep but cant quite do it

I wonder if the steroid could interfere with sleeping .
or else, i wonder if it is pain making it hard for him to sleep. How are you giving the bup? If you're giving it in the mouth you need to drip in very slowly in the pocket of the cheek. It is aborbed well via the lining of the mouth, but absorbed very poorly from the digestive tract. So if you put it in too fast and it just goes down his throat, it won't work nearly so well.
and pain makes it more difficult to heal.

my cat still can't sleep and I cant sleep either as a result.  the vet sent my cat home with buprenorphine to keep him comfortable since his prognosis was very poor.  I went back to the vet twice since then and I asked for steroids and the next day I asked for a scrip to give him sub q. fluids and after I gave him the fluids he perked up significantly and started eating again. but I stopped giving him bupe because he seems much happier without it but he still cannot sleep.   i'm sort of confused why he didn't send me home with sub q fluids and prednisolone in addition to the bupe in the first place...   do you give your cat .3ml of bupe every 8 hours continually until you run out?  am I just letting him die comfortably?  that's not what I want to do... I want him comfortable but I want to resolve the pancreatitis too...

Oh! I am sorry I forgot to tell you something that helped the last time Louis was hospitalized with pancreatitis -- plasma transfusion therapy. The vet, an ACVIM diplomate , had seen it be very helpful in dogs with pancreatitis, and thought in Louis's case it might also be helpful, and it worked so well that he said he would now always remember this as an option for cats.
I don't know if your cat's clinical findings would suggest that would be a good idea but you could mention it and maybe the vet could consider it. ( It is not cheap though. I think it was $500+)

Re the buprenorphine: Is this the first time he has had it? I'm wondering if he could be one of the minority that get more agitated from it and that could be causing the sleeplessness. You could try a different kinds of pain medicine like tramadol or butorphanol or combine one of those with a fentynyl patch.

I gave the bup based on how I assessed his condition. anything between every 12 hours to every 6 hours. ( this was on instruction of the vet who trusted me to be very attuned to how my cat felt) Usually was every 8 hours but maybe a day at every 6 hours Then as he recovered , did not need it as often went to every 12 hrs. I didn't just give it until it ran out unless he seemed to need it. Actually I have read it can be given as often as q4hr but I didn't think that was needed so I didn't ask to give it more.
I usually gave it by oral transmucosal route ( which is how I learned about dripping it in very very slowly so it would absorb in the mouth lining and not just be swallowed which would make it not work. I have given it by IM injection, but I think it works just as well per OTM . )

Cats are very stoic about pain but I think with each cat you get used to knowing what is normal for them.
I had the additional data of home testing blood glucose since he was diabetic. Pain causes stress which raises blood glucose . I had very clear evidence of BG rising and then going down after bup. at a time in the insulin cycle when it would not normally be going down. and I mean dropping like 200 mg/dL within an hour, right after the bup would have taken effect.
*****************************
I think some vets maybe don't think of sending home fluids, but as I understand it there are additional reasons why they could be a good idea besides the obvious one of dehydration due to vomiting and diarrhea ( which certainly not all cats with pancreatitis have) . I had showed my vet copies of papers from peer -reviewed journals and/or conference presentations. I don't think I have the papers any more. I had a hard drive crash .
In any case, it did seem to help Louis.

Antibiotics are not used in every case. it depends, of course, whether there is some reason to suspect infection. Sometimes Louis did get metronidazole and Baytril. But he had some times where he had both pancreatitis and an IBD flare up going on.

He was not on a steroid because it would make his diabetes worse.

I didn't make it clear that my beloved, extraordinary Louis, the cat with chronic pancreatitis, finally had to leave this life. I had to put him down last year. He was prob 15-16 years old. I had had him for 13 years.
I think if he had not developed cancer he could probably have lived for several more years. even with all his other health problems. But he was becoming very very weak and in pain. He had diabetes, chronic pancreatitis, IBD, hyperthyroidism then cancer . He had bounced back so many times and amazed the vets with what a "fighter" he was. He loved life so I wanted to give him as long as possible. I won't go into details since it's not relevant to your question but by the end the cancer was just taking over. He was so weak I had to carry him to the litter box and hold him up while he used it. and it was starting to hurt him. I didn't want to maintain him just being sedated all the time when this time he could not get better again. I told him it was OK if he was ready to go, i would help him. and would see him again later.
Your question took me back so much . Including remembering how much I cried. I still get tears in my eyes when i think of that time .

But I do hope that your cat can recover from this pancreatitis episode, and maybe will be lucky that the tumors are benign.

this would be the 3rd time with pancreatitis.  dumbdumb (my cats name- I know how wrong it sounds but it was a funny nickname that just stuck for some reason).. anyway, 7 years ago he had kidney failure and I was told I  should put him down.  the vet said they could try iv fluids but they didn't recommend it and theres a good chance he wont recover, etc.  but he did recover and i'm glad I didn't put him down... and I don't want to put him down when its not needed. 

the tumors appear to be mast cell tumors and large in size so they probably cause some discomfort.  likely malignant.  but I don't know how long they have been there or how fast they are progressing or where they originated without surgery and biopsy.  he's too old for surgery..  but I get the feeling my vet isn't trying to treat the pancreatitis.  the options he gave me were to put him down, get surgery to remove the spleen, or take him home and keep him comfy with pain meds and see what happens.   I know the last time he was prescribed special food, and this powdery stuff to put on the food,  antibiotics, bupe, and an appetite stimulant... and he recovered fine.  but this time all I got was the bupe.  I had to ask for everything else. 

vets see animals get put down every day and they probably become numb and unaffected to the experience after awhile... they suggest you put down a cat over the age of 15 that has a chronic illness.

how long did your cat have the cancer for? 

I think he probably had had the cancer for 2 years or more but we did not find out until the last several months before he died.
A few times in the preceding years I had had samples taken via ultrasound guided needle aspirate of suspicious looking places on liver, colon and spleen and they did not find cancer. Of course the other option was to go in and do surgery and look .... but the vets were not really pushing for that because the surgery would have been hard on him with his multiple complicated health problems including diabetes with a history of ketoacidosis.

Then tumors started growing so much that it became pretty obvious. but by then it was too many places to hope to get it all and he did not respond to the chemo.
I went ahead and agreed to also put him on prednisilone , though I knew it would totally mess up his blood glucose. but it did perk him up and gave him a short time of feeling better than he had been, so I am glad for that. but it did not last long

Of course I can't help but second guess and think what if I had said to do exploratory surgery in 2010 or 2011? Would we have found out in time and maybe he would still be here?n
but maybe they would not have found it then and it would not have changed things. And he might have had a very difficult painful recovery. Or he might have died during surgery and instead of gaining time might have lost it.
I just did the best I could, or what I thought was best for him.
I do know I gave him 6 years after the diabetes diagnosis. And that included 2 bouts of DKA. a few of pancreatitis including having to be hospitalized. some of the times he also had a severe inflammation of the intestines. One time he was going into shock by the time i got him to the emergency vet . his temp was so low they had to surround him with heat packs , he had had seizures that were not from hypoglycemia. and he was so out of it for a few days the vet thought he seemed brain damaged! Then within a day he fought his way back and was the star of the hospital , everyone loving him.
and that time he was not nearly so sick as when he had pancreatitis + DKA.

Would you want to get a second opinion? You could try seeing a specialist maybe? if you are around a vet school with a teaching hospital or some other specialty hospital with Internal medicine vets. If you are in the US, here is a link to the ACVIM "Find a Specialist" page. ( When you are doing that, select "SAIM" for Small Animal Internal Medicine.)
http://www.acvim.org/PetOwners/FindaSpecialist.aspx

Also check out that Yahoo group I gave you the link to the feline pancreatitis support . There may be people who have more ideas on there for Dumbdumb. ( Hey my cousin's cat was named Tinkerbutt which was a goofy name but she could not have loved her more! she lived to be 20 or 21 yrs old.)

today he's been laying in the litter box for long periods of time and he will pee while he's in there laying down....he'll come out and pace around the room, take a bite or two of food and brief drink of water then he goes right back and lays in the box.  he purrs when I come to pet him.   he seems really nervous and he still cannot sleep.   I gave him bup about 6 hours ago, sub q fluids about 12 hours ago, and his next prednisolone isn't for another 12 hours.  i'm supposed to give the bup under the tongue but I haven't been able to do this.  it always just ends up on his tongue and he swallows it.   I can even get it on the gums.  he fights it everytime.  will it still work if he swallows it instead of having it under the tongue? 

is buprenorphine the same thing as buprenex?  the prescription bottle says buprenorphine but the pre measured and loaded syringes inside have a sticker on them that says buprenex.

Yes Buprenex is just the brand name for buprenorphine.

The bup is not nearly so effective if it gets swallowed. It works very poorly from the digestive tract.

You don't have to give it under the tongue ! Believe me, I know! I had the same problem when I tried to give it that way. My cat struggled , I ended up giving the medicine too quickly and it got swallowed, so did not work well .

So then I found out it does not HAVE to be specifically under the tongue. It's just supposed to be absorbed through the lining of the mouth. I dripped it into the side of his mouth, in the cheek pocket, in between his cheek and his teeth.

And I also learned to put it in very very slowly , so that it would soak in through the lining of the mouth and would not just be swallowed. If he got impatient, sometimes I would put in part of it, then give him a break , pet him and talk to him , then drip in the rest.

Try giving it that way, maybe if he has not been getting enough relief from pain , it will help him if you can give the bup in a way that it works better.


I am worried he is not getting enough food. I think you may need to get some pate style wet food and syringe feed . Or try tempting him with mixing in some chicken baby food. Or get some Fortiflora from the vet -- it's a probiotic powder but it actually can be good to tempt a cat to eat.

Also , what about the Pepcid AC.? Are you still giving that? that might help if he is feeling a little nauseated from stomach acid.

I tried to give the buprenex to him on his gums this time...he's chillin now so it seems to be working alright.  he ate like a pig today.  so today is a good day.  i'll try to give the bup slower next time...  its so hard to see if he's in pain or not... sometimes he will be acting perfectly normal then the next time he'll be acting stressed out and uncomfortable.  thanks for the tips on the bup!

thanks for sharing your cats experiences,  maewkaew.   my cat seems to be doing pretty well this last few days... he's eating and drinking, solid poops.  but he did vomit clear liquid this morning.  i'm giving him Pepcid ac in hopes that will calm his stomach acid.  ran out of bup a few days ago and that's when he started doing better.  i'm thinking the bup may not be helping him since he got much better after I ran out of it or it could just be coincidence.  

The bup does sometimes depress the appetite, so if he seems better without it, then I would continue without it. However it is good to have on hand for the times he is clearly in pain, so I would try to get that Rx refilled if possible.

The vomiting clear liquid is very likely a sign of excess stomach acid (maybe from too long between meals?), so pepcid is good.