Sebastian Hospitalized, Has Pancreatitis - Seeking Input

My understanding is that mirtazapine does not help with nausea. People and even vets think that because the mirt makes them eat sometimes despite the nausea, but that's what sets up the food aversion. Cerenia and ondansetron are the anti-nausea drugs that I know have been used for good effect on cats.

If subq fluids are going to be given regularly, most vets seem open to teaching how it's done and selling you the supplies. I have not done it myself, but I have heard it's not difficult to learn. It certainly helps cut down on stressful vet visits. I think you can get the supplies cheaper online.

The latest thinking is that a high fat diet is not linked to pancreatitis in cats although anecdotally a few people do think that certain high fat foods triggered a flare-up. Honestly, unless you strongly suspect that he has an issue with high fat (and unless his symptoms worsened on a/d I wouldn't think so), I would look for a high quality high animal protein / moderate fat / low to no carb food. No grains or starches or fish. No carrageenan is tough to find. Basically, that leaves Nature's Variety Instinct, By Nature organics, some Tiki Cat, Hound & Gatos. This is why so many people decide to go with homemade raw or cooked when looking for specific dietary requirements. It's so hard to find commercial foods that meet all the criteria.

 Re Subcutaneous fluids -- many vets recommend doing that at home;  it's most commonly used for cats with kidney disease, but also used in other situations,   and I have had both his regular general practice vet  and a board-certified internal medicine specialist  recommend it for my cat with pancreatitis.  

I got the supplies from the vet hospitals .  But you can also order the fluids and whatever method you use to give them online;  I think it requires a prescription?

    I have given it 2 ways - 

 -- with a venoset --   with a tube that is attached to the bag,  and then you put a needle on the end of the tube and give it to the cat that way;  you hang the bag up higher and gravity does the work.

 -- and by filling up very large syringes ,  then attaching a butterfly needle with a short tube on the end of that syringe , inserting needle under the skin, and slowly steadily pushing in the fluids that way.  

 http://felinecrf.org/fluid_therapy.htm      Here is a link to the section overview  about fluid therapy,  from  a great site for feline kidney disease,  (but the tips would apply to giving the fluids to a cat with another health problem.    )    You want to look at the pages about subcutaneous fluids.  

With cats, there really is not the evidence that dietary fat makes a difference  as far as pancreatitis,  like it does for dogs.  

But if you want a food that is high protein and somewhat lower fat ,  Merrick Cowboy Cookout or Grammy's Pot Pie are a couple good choices.  

As to the sub-q fluids. you DO need a prescription for the actual fluids.  Wonder why your Vet isn't keen on you doing them at home?  Maybe because he doesn't think you'll need them long term?  Most of us who have done them at home have cats with chronic conditions, so maybe that's the difference.  Sebastian shouldn't need them over the long run, I'm hoping

OK, I probably read through this thread too quickly, but having just gone through this with Ming Loy and similar symptoms due to the virus we assume she had passing through several more of my cats, the one thing I didn't see mentioned here is small, frequent meals. Carolina emphasizes the importance of getting his daily caloric need into him, but with a kitty with pancreatitis, that isn't necessarily the focus the first few days (I know I missed the beginning of this, and I'm glad he's overall feeling better. :cross: ).

1) If he's eating a minimum of 15 calories per pound, the risk of fatty liver is basically eliminated, no matter how much food he was eating before.

2) The first few days, if he's eating at least 50% of what he normally eats, he should be OK.

When Ming Loy had the inflamed pancreas, we offered her 0.25 ounce meals of chicken babyfood every 2 hours. She's little, and normally eats 3 ounces of raw food a day. I don't know what your schedule is, or the schedule of people at home. But the more often you can offer him food, the better.

Sub-q fluids. We gave Ming Loy 50ML of sub-q fluids every day. That's not a lot compared to CRF kitties, but it keeps kitty hydrated and flushed. Treatment with sub-q fluids is pretty standard when treating pancreatitis. :nod: I have tips on how to do it. If he likes brushes in the bathroom, then it most likely won't be difficult if doesn't sense your hesitation or fear.

If he's not eating enough food, or assist-feeding him (whether with syringe, finger, or spoon) is too much of a hassle or stressful for him, then I would consider the tube. I disagree with people who think "not eating" means something sinister. It means they're nauseous. One of the main reasons people can have the flu and not feel like eating for weeks and that's OK, but it isn't OK for cats is because their bodies lack the ability to downregulate protein metabolism, so their bodies will start "eating" their muscles if they don't get food. So for cats, in many situations, food IS the treatment. Anyway, before the tube, get Cerenia into him (we used this for Ming Loy - she only needed it for 2 or 3 days, but when Lazlo was going through chemotherapy, we used it daily for six months). If that doesn't help, add the appetite stimulant (if you haven't already). And if those don't do the trick, then go for the tube.

I'd switch him to an all wet food diet. Fancy Feast classic pates are an OK choice: they're high protein, medium fat, low carb, and most cats love the smell, especially if they were kibble eaters. Of course, right now, whatever he'll eat is probably best for him. For Mingle, we used chicken baby food for a few days, because she loves it, and it's easy to digest.

You can consider using digestive enzymes on the food to make it easier to digest. We use Prozyme original, it takes just a pinch. Put it on the wet food, and let it sit for 10 - 15 minutes before feeding if you can (it starts to "predigest" the food).

With the anti-nausea med, an antibiotic (which your kitty already received), the daily fluids, the frequent small meals, (Mingle never needed the appetite stimulant), it took her a little over the week to have the crisis resolve. Knock wood, it was an acute bout, not chronic. Hopefully it will be the same for your boy.

Also consider, once he's better, to use 250mg of lactoferrin on his food daily. I use Jarrow. This will help his teeth & gums and his overall immune system (especially if you combine it with a good (human quality) probiotic). :nod:

No, mirtazipine (in my experience) does not help with the nausea, and cerenia works completely differently than pepcid. Lazlo, during chemo, needed all three, though the cerenia did more than anything to help him regain his ability to eat; the mirtazipine increased the frequency and amount he wanted to eat. All pepcid does is suppress acid creation / build-up.

This is written by the head Doctor at Idexx labs: http://www.idexx.com/pubwebresource...ng-pancreatitis-and-concurrent-conditions.pdf

Thanks all. I really appreciate your input. I, too, hope it's just an acute case. I figured the fluids would help, if only for a week or two, to keep his pancreatitis at bay and help him recover. It's been a week now and I can tell he is not himself yet. I just feel like he needs something temporarily to help him along, and I don't think asking for Cerenia and fluid supplies (and perhaps B12) is too much to ask...which I plan to do as soon as the docs call me back! I'll look into Prozyme.

Unfortunately, I work full-time and I live alone. I probably spend an hour to two in the morning and at night encouraging him to eat and trying different things. He does eat a little on his own. I keep watch and try to calculate. When he's "done", I prepare the syringes for whatever remaining calories he needs, divided between AM and PM.

He is being a picky eater and won't touch any of the junk wet foods I bought for him (Friskies, Fancy Feast, 9Lives, Whiskas...all pates because that's what he prefers). I tried the chicken baby food and tuna water mixed with a food. The only thing he's eaten on his own so far is Natural Balance Chicken & Liver Pate, which is high in calories but does have ground brown rice in it. Like you said, at this point, I'm letting him eat what he'll eat and I can concentrate on something better later. I'm so fed up with commercial pet foods (a whole other discussion). They keep changing formulas and it is getting stressful to find decent foods my cats will eat. Sebastian loved the By Nature foods until they changed their formulas. He won't touch them now. I did a trial run on raw feeding, but it was a no-go and I just don't have the time and energy right now to dive into that. I also have an autoimmune disease that I have to manage, but I swear I take better care of my cats than myself!

So funny you should post that link, LDG. Just yesterday, I found the same document from an internet search and it is very helpful.

:nod: It's probably the best document out there on pancreatitis. Glad you found it already. There just isn't much, because they still haven't figured out the why.

Aw... I think many of us take better care of our cats than we do ourselves. I actually am trying to start taking better care of me and hubby, and I aspire to the level of care I give my cats. :lol3:

I hope your vet is back soon. I'm sure he'll do better with cerenia, B12, and fluids. :nod:

If your vet agrees to the fluids at home, basically you just have to get over your fear of poking him with the large looking needle. I stuck one in an orange a couple of times first, just to get used to pushing quickly and the feel of it.

First thing I do is put the fluids in a large bowl of hot water, let it sit for 10 minutes and refresh the hot water (when the bag is full - when it's closer to empty, it warms up more quickly) and let it sit another 10. They don't even seem to notice it when the water is warm. :nod: I use a suction hook stuck to a bathroom mirror to hold the bag. Most people can just hang it from something hanging from the shower rod, but we don't have one. The first time, it helps to have everything set up first. Sit on the floor, make sure the little thingy that turns the stream of water on and off is easily accessible. Run some into the sink, so there's no air bubbles, and it's ready to go (and make sure it feels warm to the touch). Clean the needle with alcohol, and put the top on so you're ready to go.

Get settled comfortably on the floor - however he'll lie near you, with his back up while you brush his cheeks, head or sides (you say he loves the brush). Sit and brush him for a minute or two, especially between his shoulder blades. Talk to him and tell him what you're doing, and it'll make him feel SO much better... The first time you do it, pick up and kind of pinch his skin there a couple of times, so the needle prick won't be a foreign feeling. When you're ready, take the top off the fluids needle, have an alcohol pad ready to go. Pinch the skin between his shoulder blades with one hand, rub quickly with a little alcohol, and place the needle on his skin, and push firmly. Don't be scared if you actually have to POKE it in there. He may flinch, but once it is IN, he won't notice it. I always made sure the tube was lying loosely, so if kitty moves around a little bit it doesn't pull the needle out. Then push the little wheel up (you'll see when you see the set up) so it's just a slow drip. When you're comfortable he's comfortable, you can increase the drip rate. Whether giving him 50ML or 100ML, you will see a big "blump" as I call it, forming on their back, maybe off a little to the side. That's normal, and depending on the size of kitty, if 100ML it can look a little large. :lol3: You can keep brushing him while the fluids go in. My cats actually really enjoyed getting their fluids, because all they really cared about was being alone in the bathroom getting brushes. :lol3: Turn the little wheel so there's no more drip before you pull out the needle.

When you pull it out, rub with an alcohol pad, and kind of "push" on it a bit, or the water will start leaking out. If it does, don't worry. Some may, and it's not doing any harm.

...like I said, the love of being brushed really helps when it comes to giving fluids. They're so focused on something they love, and you feel good because they're happy... the fluids just become part of the "background," so in and of themselves aren't a stressor. :heart2:

Aw, thanks so much for the detailed instructions!

Yeh, I have GOT to take better care of myself. Otherwise, I won't be any good for anybody.

I stopped by my vet tonight to pick up some of Sebastian's records that I requested (bloodwork, ultrasound report, etc.), and I feel like the nurses and receptionists kind of blew me off. They were so good to me and Sebastian last week. I think maybe I'm being overly sensitive. I'm a little stressed and emotional right now.

He seems to be doing a little better each day, and he ate a tad more on his own tonight. I only needed to give him one syringe full, which was about 1/8 can of A/D.
 

Yep, it can be slow going. But he's getting better, and that's what matters. :heart2:

...I'm sorry you felt like you got the cold shoulder. Maybe they thought you were picking up his records because you're taking him somewhere else, or they were just busy / having a bad day.

And please take care of you, too! :heart2: It's often so much easier to focus on others, but it IS important we take care of ourselves. Of course, I ate toast for breakfast...

Okay, so I talked to the doctor finally. She was out with laryngitis, so I could barely hear her and she couldn't talk much.

Since we've seen improvement, she doesn't think he needs additional fluids as long as he's drinking and urinating normally. I mentioned Cerenia, and she wants me to try the Mirtazapine. The thought was if he's eating some, then he must be feeling a little better and we want to increase the amount and frequency (like what LDG said above). So, I guess I'll try that tonight and see what happens. She did, however, agree to give me some B12 injections, so I'll be picking those up tonight.

I'm so glad you got in touch. It's always nice to discuss the next steps with someone we trust. :heart2:

What a handsome boy he is! Aw... he looks like a sweetie. :rub:

I hope the mirtazipine makes him start pestering you for food. :lol3: For Lazlo, he'd be by asking for food ALL the time the first day or two. It tapers off after that. But maybe this will help kick-start his appetite again!

I am so glad to hear Sebastian is doing better.   He does look like a sweet boy. 

Okay, so I'm thinking of setting up a wireless webcam in my kitchen...with remote access.   Perhaps a new thread...

I left a little dry food out at each of their "stations" while I was at work and a lot of Sebastian's food was gone when I got home, so I don't know if he's eating it or one of the other cats is eating it. That would be helpful to know!

He really is SO sweet. He lays on my chest every morning (and drools). He's under my feet every second wanting to be petted and kissed. He's the sweetest animal I've ever had. The other two are more independent.
 

So I rushed Sebastian into the vet this morning at 11:30 before they closed at noon. I woke up to a bit of dark vomit and a small black hairball nugget. The vomit was the same color as the vomit he had with pancreatitis. So, I'm immediately concerned. I cleaned it up and proceeded downstairs to prepare their breakfast. While in the kitchen I heard someone puking in the living room. It was Sebastian again, except this time it was a watery red-tinged liquid (blood?). Ugh. I took him in for fluids and a Cerenia shot. His regular doc isn't back in until Monday.

I'm looking into some more things to help Sebastian with his issues.

LDG, I've read varying opinions about use of a digestive enzyme supplement, such as Prozyme, for cats with this condition. Pancreatitis occurs when digestive enzymes prematurely escape into the pancreas (rather than the digestive tract) and begin digesting the pancreas itself, causing the inflammation of tissue and that of surrounding organs. Some believe that supplementary digestive enzymes would exacerbate the issue since there are already enzymes present causing a problem. Others believe that a supplement would give the body the enzymes it needs and therefore give the pancreas a rest. I'm not sure what to believe.