Sebastian is Back at the Vet...Suspected Pancreatitis Again :(

goholistic

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Here we go again. I feel sick to my stomach. I swear I jinxed him. Just three days ago I was saying how great Sebastian has been doing. He's been playing like I've never seen him play before. He's been so happy.  


He didn't want to eat much yesterday morning. Last night, he didn't want to eat at all. Around 9:00 p.m. he started vomiting and it continued until 1:30 a.m, a total of about six times. Then he jumped up on the bed with me and tried to sleep. I didn't get much sleep. I kept looking over at him and observing his respiratory rate. At one point he actually looked very comfortable, so I tried not to move so as not to disturb him. I wanted him to rest. I called the vet at 7:00 a.m. as soon as they opened and brought him in.

The doc called a little bit ago and said she wants to run blood work. This was expected. We have to see if his neutrophils have spiked again. If so, we need to get him through this with hospitalization, IV fluids, etc. and try to come up with a plan to prevent it. We discussed the hairball issue and she agreed that frequent hairballs are a result of a GI issue and that hairballs can aggravate an existing GI issue. Her words were, "It's a vicious cycle." She mentioned IBD again and a possible biopsy....ahhh! At this point, we don't really know what's causing the pancreatitis. The previous ultrasound he had done was normal. So frustrating.

If, by some miracle, his blood work is perfect, I will be ecstatic. 


It's only been six weeks since his last bout of pancreatitis (which I posted here: http://www.thecatsite.com/t/262314/sebastian-hospitalized-has-pancreatitis-seeking-input). My poor Sebastian. I know we with multiple cats don't like to play favorites, but he really is "my guy" and it tears me up to see him unwell.

If anyone out there has a cat with recurring pancreatitis, any advice on how to keep it at bay would be appreciated. I've already eliminated many allergens from his diet and still working on transitioning him to an all wet diet (then possibly to raw or home-cooked, but it's a slow process). I've been researching digestive enzymes, but have not started Sebastian on them. There seems to be varying opinions on their effectiveness for pancreatitis - whether it helps or hurts the condition. There are docs out there that say antioxidant supplementation is beneficial for pancreatitis/IBD, but not if it should be, or turn into, cancer.

 
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goholistic

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Thanks, vball91. I do have that document. Many of the treatments recommended by Idexx are what's on Sebastian's "regime" at the vet. During a flare, he gets IV fluids, Fentanyl pain patch, Cerenia antiemetic, famotidine antacid, Mirtazapine appetite stimulant, and sometimes an intestinal antibiotic like metronidazole. For maintenance, he gets weekly B12 injections and sub-q fluids at home.

The only two things we haven't tried is a glucocorticoid (which the doc said she may want to try next...ugh) and antioxidants.
 

vball91

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I figured you had that document already since you seem like a good researcher.


I think the toughest thing is not knowing what causes the flares, and every case seems to be different. I wonder if keeping a journal of his daily activities (food, elimination, meds, etc.) might be able to help pinpoint a pattern?
 

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I have no advice, just wanted to say how sorry I am. Pancreatitis is awful.
 
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goholistic

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I figured you had that document already since you seem like a good researcher.


I think the toughest thing is not knowing what causes the flares, and every case seems to be different. I wonder if keeping a journal of his daily activities (food, elimination, meds, etc.) might be able to help pinpoint a pattern?
Yes, I suppose I could start a journal. It's usually in my head, but I can't always rely on my memory 100%. Thanks for the suggestion.
 
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goholistic

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Talked to the doc. The blood work does not show pancreatitis at this point, but his white blood cell count is slightly elevated. She said it's not near as bad as it was before, so she's not overly alarmed. I forgot to ask if she did the specific pancreatic lipase test, but I'm pretty sure she did. These guys are pretty thorough. We both agreed that we may have caught it at the very itty bitty early stages, so that is good. Although, I wish it didn't happen at all.

Given our conversation about hairballs, she wants to do x-rays. She also wants to keep him overnight for monitoring.

I'm so lucky so have found a vet that I trust. I feel so confident and comfortable when my cats are in their care, even when it's overnight. The last time Sebastian was hospitalized, the doc made a special trip out there from home each night to check on Sebastian and called me at 10:00 p.m. to give an update. I was speechless at such dedication and service. So now I'm hoping we can all get our brains together and figure out how to keep my "Bastie" happy and healthy.
 

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I'm so glad you have a vet you love and trust. That is so important (and hard to find in my experience). I believe the spec fPL test still needs to be sent to Idexx, so she may not have the results yet. The snap fPL gives instant results but is not as reliable. Continued vibes for Sebastian to feel better soon.
 

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I spoke with Cornell when my horse had Cushing's...would your vet consider bringing in an endocrinologist?

ETA: we spoke with another vet school too about his pemphigus. In any case, it might be worth him calling a school or two?
 
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Just want to say that I'm really sorry that you're going through this and I hope you find out soon what's going on so that Sebastian can start feeling better as soon as possible.
 

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Oh hun, I'm SO sorry! :hugs: :hugs: :hugs: And poor Sebastian! :rub:

Yes, having a vet you trust is SO important, especially during times like this I'm sure you're aware, but nailing down pancreatitis can be difficult. The spec fPL may be normal, but inflammation seen on an ultrasound; sometimes it's the reverse.

I don't know that an x-ray will help determine whether or not there's a hairball. In fact, hairballs usually don't turn up on x-ray, is my understanding. Even an ultrasound can only see if something is there, not necessarily what it is. :( Of course, if he's on just fluids, when x-ray or ultrasound is done, there shouldn't be anything in his tummy.

I'm so sorry he has to be hospitalized.

I must say... it does sound like it could be IBD, and it's possible that is what precipitated the pancreatitis flare before. The facts of the matter are they have no idea what causes pancreatitis, and for all we know, cats with frequent hairballs or vomiting have their numbers out of whack, or an inflamed pancreas, it's just it may be self-resolving given the usual treatment is to fast for a while, put a cat on fluids, or feed frequent small meals, so the tests aren't run and ultrasound isn't done, so we don't know the inflamed pancreas ever happened. That SO could have been the case with Ming Loy, but rather than just bring her home, feed her small meals and give her IV fluids at home, we had the ultrasound done. Never would have even known if not for that, you know?

I don't know if you want to discuss with the vet ideas like... treating for IBD with pred before doing a biopsy. The pred may interfere with biopsy results if those are needed down the road.... But if he responds well to pred, then wouldn't it point to IBD being the source of the problem? :dk: Just putting the idea out there. No idea if it's a good one.

:vibes: :vibes: :vibes: :vibes: :vibes: Sebastian and :hugs: for you.
 

ldg

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...honestly, in your shoes, I'd be putting him on a salmon or krill oil supplement (starting small and working up to the 500mg daily dose) and probably an acidophilus+bifidus supplement. Or at least discussing those with the vet.
 
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goholistic

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Thanks for all your replies.
 
I believe the spec fPL test still needs to be sent to Idexx, so she may not have the results yet. The snap fPL gives instant results but is not as reliable.
Ah, yes. It may have been the snap.
I spoke with Cornell when my horse had Cushing's...would your vet consider bringing in an endocrinologist?

ETA: we spoke with another vet school too about his pemphigus. In any case, it might be worth him calling a school or two?
I can ask about an endocrinologist.  It might be good to get the opinion of someone who knows the pancreas in and out.
 
Just want to say that I'm really sorry that you're going through this and I hope you find out soon what's going on so that Sebastian can start feeling better as soon as possible.
I appreciate that.
I don't know that an x-ray will help determine whether or not there's a hairball. In fact, hairballs usually don't turn up on x-ray, is my understanding. Even an ultrasound can only see if something is there, not necessarily what it is.
Of course, if he's on just fluids, when x-ray or ultrasound is done, there shouldn't be anything in his tummy.

I'm so sorry he has to be hospitalized.

I must say... it does sound like it could be IBD, and it's possible that is what precipitated the pancreatitis flare before. The facts of the matter are they have no idea what causes pancreatitis, and for all we know, cats with frequent hairballs or vomiting have their numbers out of whack, or an inflamed pancreas, it's just it may be self-resolving given the usual treatment is to fast for a while, put a cat on fluids, or feed frequent small meals, so the tests aren't run and ultrasound isn't done, so we don't know the inflamed pancreas ever happened. That SO could have been the case with Ming Loy, but rather than just bring her home, feed her small meals and give her IV fluids at home, we had the ultrasound done. Never would have even known if not for that, you know?

I don't know if you want to discuss with the vet ideas like... treating for IBD with pred before doing a biopsy. The pred may interfere with biopsy results if those are needed down the road.... But if he responds well to pred, then wouldn't it point to IBD being the source of the problem?
Just putting the idea out there. No idea if it's a good one.
I had forgotten what an x-ray shows and doesn't show. Perhaps she's using it to see other things, as well. I'll ask when she calls with the results. The doc does think it's some kind of GI disease and that he has inflammation. She talked about trying a true novel protein diet, like rabbit, but I just know he won't eat it. She may want to try the lowest effective dose of pred. I just worry about the side effects. Wouldn't a good response to pred also mean it could be lymphoma? 
 

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I had forgotten what an x-ray shows and doesn't show. Perhaps she's using it to see other things, as well. I'll ask when she calls with the results. The doc does think it's some kind of GI disease and that he has inflammation. She talked about trying a true novel protein diet, like rabbit, but I just know he won't eat it. She may want to try the lowest effective dose of pred. I just worry about the side effects. Wouldn't a good response to pred also mean it could be lymphoma?  :(
Yes, it could. :( It could also make a more definitive diagnosis difficult. Biopsy prior to pred is always preferable. Some people prefer to treat prophylactically for a short period to monitor response before an invasive option.

The problem, of course, is if he responds well to the pred, if you then take him off the pred, getting him on the novel protein diet is the problem. Because responding well to that would be a good indicator it's IBD, not lymphoma.

Have you tried anti-nausea meds or antacid? I always wonder about "picky" kitties - especially when it turns out that there is an underlying problem, which there appears to be with Sebastian. :heart2: Are they truly finicky? Or they appear to be finicky, because they don't feel well? I'm sorry, I don't recall if you've tried anything to help settle his tummy. I know you prefer holistic options over meds. What our holistic vet had us do with Chumley was a combo of (George's) aloe vera juice, slippery elm bark powder, and probiotics. It helped to calm his insides down quite a bit.

ETA: and an omega 3 isn't contraindicated for ANY potential issues, and wouldn't confuse test results, etc.
 
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goholistic

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...honestly, in your shoes, I'd be putting him on a salmon or krill oil supplement (starting small and working up to the 500mg daily dose) and probably an acidophilus+bifidus supplement. Or at least discussing those with the vet.
My cats hate salmon oil. I even tried to get an unscented salmon oil, but then it just reeked of rosemary extract (natural preservative). I was going to try krill oil, but I read in another thread on TCS that someone's cat hates krill oil, so now I don't know what to get.

I had Sebastian on a good human grade 10-strain probiotic, but then I took him off of it because of some references I found that said they may not be good for a cat with pancreatitis:

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

http://www.epi4dogs.com/apps/forums/topics/show/9170878-probiotics-and-cats-with-pancreatic-issues

http://www.reuters.com/article/2008/02/14/us-pancreatitis-yogurt-idUSL1357056420080214

I don't know what to believe.
 

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No sardines either? My cat that doesn't like salmon or krill likes sardines.

And when you tried the salmon oil, did you give it all in one dose on the food? Because mine won't eat it if I use it that way. I counted out the number of drops in the pill I use with the knife I use to make the cut in its seem, and divided by 6 (because it is a 1,000mg supplement). I add four drops of salmon oil at each of three meals, and they get their total. But I worked them up to it, starting with just one drop on the food, then powdered freeze dried chicken over it (but anything else he likes could be used).

As to the probiotics and pancreatitis.... wait to see if this is pancreatitis.

I wasn't able to find the research done in cats (the actual research) that is referred to in the 2nd link. Maybe your vet can? Because the research in humans was associated with severe acute pancreatitis - where people in the placebo group died. http://www.thelancet.com/journals/lancet/article/PIIS014067360860207X/abstract?isEOP=true

But the suggestion for probiotics was based on the indication that this is IBD (or lymphoma), not pancreatitis. Same goes for the suggestion of (George's) aloe vera & slippery elm - especially if you want to avoid pred for now (which I also saw has been indicated as a trigger for episodes of pancreatitis, even though this completely contradicts the info on the CRF site :dk: ) : http://healthypets.mercola.com/sites/healthypets/archive/2010/10/05/pancreatitis-in-pet-cats.aspx ).

Just more to discuss!

:vibes: :vibes: :vibes: :vibes: :vibes: :hugs:
 
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goholistic

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Yes, it could.
It could also make a more definitive diagnosis difficult. Biopsy prior to pred is always preferable. Some people prefer to treat prophylactically for a short period to monitor response before an invasive option.
Why is a biopsy prior to pred preferable?
The problem, of course, is if he responds well to the pred, if you then take him off the pred, getting him on the novel protein diet is the problem. Because responding well to that would be a good indicator it's IBD, not lymphoma.
Why would getting him on a novel protein after being on pred be a problem? I actually would think that the novel diet would come first to see if he responds well to it. Oh wait...I just answered my own question. 

Have you tried anti-nausea meds or antacid? I always wonder about "picky" kitties - especially when it turns out that there is an underlying problem, which there appears to be with Sebastian.
Are they truly finicky? Or they appear to be finicky, because they don't feel well? I'm sorry, I don't recall if you've tried anything to help settle his tummy. I know you prefer holistic options over meds. What our holistic vet had us do with Chumley was a combo of (George's) aloe vera juice, slippery elm bark powder, and probiotics. It helped to calm his insides down quite a bit.

ETA: and an omega 3 isn't contraindicated for ANY potential issues, and wouldn't confuse test results, etc.
Yes, I actually have most of the supportive treatments here at home other than the Fentanyl pain patch. I guess they don't like to just give those out. The last time Sebastian was hospitalized, they sent me home with a bag for sub-q fluids. She now wants to start doing that twice a week instead of once. I also have Cerenia, Pepcid, metronidazole, and B12 injections. Sebastian doesn't pill well and immediately starts foaming at the mouth. He hasn't needed any of these medications, though, because he was doing well. These "episodes" creep up so quickly that I don't even have time to respond. He goes from happy and eating to anorexic and vomiting within 12 hours.

I agree about the "picky" kitties. Now that I've experienced it first hand, I think there could be underlying issues with other picky kitties out there. Speaking of which, now Boo is being "finicky" and he's usually my good eater. I can't catch a break!

I do have SLB at home, as well as marshmallow root. But again, Sebastian doesn't like stuff in his food. If he smells it, he walks away. Caesar is the same way, but I had to get aggressive with him in making sure he gets his supplements, so I crush everything in a mortar and pestle, add water until dissolved, and give it to him with a syringe. I could try doing the same with Sebastian for those supplements that may help him.

I'm realistic when it comes to holistic vs. traditional medicine. If there is a safe, gentle holistic option for a minor non-life-threatening issue, then I'm willing to try it. But I understand that meds are often are needed for more serious conditions. I guess you could say I like to balance both.
 
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