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

LDG said:

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

) : http://healthypets.mercola.com/sites/healthypets/archive/2010/10/05/pancreatitis-in-pet-cats.aspx ).

Just more to discuss!

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Someone else mentioned a "small fish" oil, I guess like sardines, but I haven't looked into it yet. When I did the salmon oil for my cats, it was only 1/8 teaspoon in their wet food, which is basically only a couple of drops. All three cats sniffed and walked away. HOWEVER, it was a pump and preserved with rosemary extract, and the rosemary was pretty overpowering. I do have Welactin gel caps that I poked and dripped onto the food, but they were refused as well.

In reference to the probiotics and whether or not this is pancreatitis or IBD, I know that IBD can affect different parts of the GI system. Upper GI would produce vomiting, upset stomach, etc. Lower GI would cause diarrhea. Some cats have both. Could IBD somehow decide to pinpoint just the pancreas, if it is the pancreas we're dealing with?    I suppose IBD could cause inflammation of any of the GI organs, right?

The vet did call just before they closed for the night. She caught me at a bad time while I was at work, so I couldn't ask many questions. I'll be talking to her again tomorrow. She said Sebastian is resting comfortably, but is still refusing to eat on his own. No more vomiting. They were going to syringe feed him a little there. Doc said x-rays "came out fine" and everything was normal. She asked me earlier if it was okay that she give him an enema. She felt quite a bit of stool during the physical exam and figured it wouldn't hurt to get that out as it might help with how he feels overall. When she called tonight, she said he passed a very hard, dry stool and was straining quite a bit. 

I found an interesting document that discussed pancreatitis in a very scientific way (http://www.iowapetadoptions.com/sites/default/files/manual/sag.pdf). It's only a part of some book or research study, and I can't find a date of publication or author. But anyway, it talks about the whole process of the pancreas releasing the enzymes too early and stuff. I could barely understand it. There is a small section that says treatment of pancreatitis with steriods is not considered to be contraindicated. Who knows!

I am so sorry that Sebastian has pancreatitis  flaring up again.    Believe me I can relate to how you must feel  since I have dealt with chronic feline pancreatitis in my beloved Louis.    ( who also had diabetes.  and IBD.   and then lymphoma.  which is what  he finally could not overcome.  

 But he did live for several years with chronic p-itis.    He would have several flare ups a year but usually just one or two serious ones.    I became  very attuned to how he was feeling and most of the time was able to catch it     quickly enough and was able to stop it gettin much worse.   ( and in his case it could easily have killed him;  the first time he was diagnosed with pancreatitis,  he ended up in diabetic ketoacidosis 

Dietary fat did not seem to make a big difference.   for a while I did try to feed a food lower in fat since that supposedly helps dogs .    but there is no

I was both observant to his eatning and his demeanor ,  and also since he was diabetic,  I was testing his blood sugar.    I have never heard of someone doing that with a non-diabetic cat with chronic pancreatitis so I don't know if it would be as useful.   but seeing his blood sugar go high with no other cause often meant inflammation. 

 He got Buprenex for pain , 

  sub -q fluid therapy to replenish fluid & electrolytes and  flush out inflammation, ,

 famotiine  for stomach upset and 

Cerenia if worse nausea /  vomiting. 

Occasdionally an appetite stimulant like cyprohetadine

Denamarin  (denosyl +  marin)   -  a liver support medicine.   He needed this espceially one time when  he almost got hepatic lipidos

Vitamin B12 injections.  ( he had been tested as low in it.    this is more related to intestinal disease  but they often do seem to go together.) 

Plasma transfusion -    Hopefully Sebastian won't get it really bad again.  but  this wa something that we found helpful was a plasma transfusion.   that worked wonders. 

GoHolistic said:

In reference to the probiotics and whether or not this is pancreatitis or IBD, I know that IBD can affect different parts of the GI system. Upper GI would produce vomiting, upset stomach, etc. Lower GI would cause diarrhea. Some cats have both. Could IBD somehow decide to pinpoint just the pancreas, if it is the pancreas we're dealing with?  :dk:   I suppose IBD could cause inflammation of any of the GI organs, right?

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But do we know his pancreas is currently inflamed? Sounds like the x-ray indicated it isn't? :dk: And you don't have the results of the spec fPLI test back yet?

I am by no means an expert on IBD, and haven't done a lot of research on it. But whether the IBD is affecting upper GI, lower GI or wherever, the issue is one of the GI system - and immune system of the cat - not functioning properly. IBD doesn't happen in isolation. :dk: ...and I suspect pancreatitis doesn't either. But I tend to try to think "whole animal."

The fact is we don't know what causes the pancreatitis, or what precipitates what. (And right now, we don't know Sebastian's pancreas is even involved in the current problem).

Yes, steroids are often included as a part of the treatment for pancreatitis. Unfortunately Dr. Becker didn't reference her comment that pred has been known to trigger pancreatitis.

...but I think this just points to how little is actually known about the causes, issues, and most effective treatments of feline pancreatitis.

The biopsy is more accurate if done before giving pred.  The biopsy is to find the cells that the pred suppresses, how many there are and how they are clumped together.  The pred suppresses and clears out the inflammatory cells so the results of a biopsy would not be accurate.

Thank you Denice, I forgot to address that.

GoHolistic said:

Sebastian doesn't pill well and immediately starts foaming at the mouth.

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My Spooky is the same. She's the reason I got good at pilling. :lol3: Whenever she needs meds, I put them inside of a small gel cap, the smallest that will take the medication she needs. I hold her, sit behind her with my knees on my butt, my legs out in a V. I hold her head firmly with one hand, the pill (in the gel cap) ready in the other. I push her jaw open with the hand holding her head, and slip the gel cap over the hump of her tongue, at the top of her throat. I then close her mouth, hold it closed for a moment while I stroke her throat until she swallows (all the while telling her WHAT a good girl she is!). Then I give her a morsel of something wet to follow it. It used to be a dollop of canned food, now it's a small piece of chicken breast (not freeze dried).

Obviously it wasn't as quick and easy at first, and there was thrashing and scratching. My finger usually gets bitten, and I have a permanent callous on the outside of my right-hand index finger, because I've had a lot of cats requiring medication over the past 2 - 3 years. I treat those bites with colloidal silver. I also make SURE to keep the claws of any cat that needs medication really well clipped.

Don't know if this will help, but thought I'd put it out there. :rub:

GoHolistic said:

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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Likewise. :nod:

Denice said:

The biopsy is more accurate if done before giving pred.  The biopsy is to find the cells that the pred suppresses, how many there are and how they are clumped together.  The pred suppresses and clears out the inflammatory cells so the results of a biopsy would not be accurate.

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If I remember from BarbB's thread, they had to wait 6 weeks after stopping the pred to do the biopsy.

Quick question? I don't know how far north in Delaware you are, but have you searched to see if there are any holistic DVMs you can get to? I searched to see if there are any trained in chinese meds in DE, and there aren't. But perhaps some place in MD or PA may be accessible? (Or is traveling any length of time too stressful for Sebastian? :rub: ).

I work with three vets at different practices, and they all know it; one is a holistic vet (DVM) that also uses traditional treatment, but will also provide supporting care in combination with conventional treatment from one of my other vets. I keep everyone's files current at all vet practices.

If you haven't already looked, you can search here: http://www.ahvma.org

 btw here is  another article ,  by vets at Texas A&M's Gastrointestinal Lab, on Chronic Pancreatitis in Dogs and Cats ;                                                                                                                                                                   http://www.2ndchance.info/pancreatitisdogXenoulis2008.pdf

Very interesting piece from Texas A&M. :nod: "...mild pancreatitis was identified in almost half of the apparently healthy cats..."

That got me curious... With a very quick search, I found this information re Chinese Medicine and pancreatitis.

From the Univ of MD:

Individual case reports suggest that Traditional Chinese Medicine (TCM) can be effective for preventing and treating pancreatitis. To determine the right regimen, consult a skilled herbalist or licensed and certified practitioner of TCM, and keep all of your health care providers informed of any supplements, herbs, and medications you are taking.

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http://umm.edu/health/medical/altmed/condition/pancreatitis

And this:

Xi-ping Zhang, Da-ren Liu, and Yan Shi 2007. Study progress in therapeutic effects of traditional Chinese medicine monomer in severe acute pancreatitis, J Zhejiang Univ Sci B. 2007 February; 8(2): 147–152.

Severe acute pancreatitis (SAP) is a common acute abdomen clinical problem characterized by high mortality, multiple complications, complicated pathogenesis and difficult treatment. Recent studies found traditional Chinese medicine (TCM) monomers have markedly good effect for treating SAP. Many TCM monomers can inhibit pancreatin, resist inflammation, improve microcirculation and immunoloregulation, etc. to block the pathological progress of SAP in multiple ways, reduce complications and lower mortality with rapid effects...

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It's the full report, not just the abstract.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1791063/

maewkaew, thank you for telling me about your experience with Louis. It seems we are doing everything you already mentioned. I will look into Denamarin in case Sebastian needs a liver support supplement. I, too, hope he doesn't get so bad that he would need a plasma transfusion, but at least I know that is an option.

Denice, thank you for clarifying why a biopsy should be done before starting pred. I understand now. This is very helpful information.

LDG, we do not know that the pancreas was inflamed. The quick "x-rays were fine" comment from the doc was a result of the verbal conversation with the consult. The official x-ray report won't be in until Monday, but I suspect there won't be much there. We did not have the spec fPLI test done. They did the snap test in-house, and it came back negative. If/When Sebastian gets another flare, I'm going to request that the spec fPLI be sent out. I appreciate you reiterating that we don't know what causes pancreatitis. I just have trouble accepting this. I hate the unknown. It's bad enough in my own personal life that they "don't know" what caused my autoimmune disease, but I have a harder time accepting this for my babies. And thanks for telling me how you pill Spooky. I may need to find those gel caps. It's funny you should ask about a local holistic vet! Before you posted that, I was looking around. Turns out there are a couple at Wilmington Animal Hospital (www.wilmingtonanimalhospital.com). I actually stumbled across their site looking for pet acupuncture/chiropractic services for Boo's hyperesthesia and seizure-type episodes. I called to make sure the main doctor was accepting new patients and she is. It's about 25-30 minutes away, which would add to Sebastian's stress. Our current vet is only 8 minutes away.

And thanks, maewkaew, for the article from Texas A&M. I'm going to add this to my "Pancreatitis Research" folder.    The research links that LDG provided are also helpful in understanding pancreatitis. I believe these links were related to pancreatitis in humans?

Okay, so an update...I picked up Sebastian on Saturday morning. They said he was up and at it and being very lovey with the vet techs (that's my boy ). I let him settle in for 20 minutes before trying to feed him. He wanted to eat right away, but didn't have an interest in wet food, so I gave him a little dry. He ate some wet that night as well as some dry. On Sunday morning he ate VERY well and I even managed to get away with not giving him dry food!   He ate an entire 3 oz. can of Natural Balance Duck & Green Pea, which is really good for him. Sunday night he ate almost a half of a 6 oz can of wet and just a teaspoon of dry (which is basically like 10 morsels). He took a nap with me today and seemed comfortable. He did have some runny stool leftover from the enema.

It's very possible that this is not necessarily the pancreas this time (or we caught it early enough to prevent it). But his blood work does show that something was/is going on. He had no fever this time. Here are the numbers that were out of range. Everything else was normal.

MCHC 37.7 (range 30.0 - 36.0)

CRE 2.4 (range 0.3 - 2.1)

WBC 21.52 (range 5.50 - 19.50)

MON 1.76 (range 0.00 - 1.50)

MO% 8.2 (range 1.0 - 3.0)

I was doing some research on biliary and pancreatic duct obstruction and that had me intrigued, whereas the enzymes releases by the pancreas don't ever get to leave the pancreas due to duct obstruction, and therefore become active within the pancreas itself causing the pancreatitis. The "obstruction" could be inflammatory cells. Of course, I was trying to research if hair could cause the obstruction.

From http://www.marvistavet.com/html/body_feline_cholangiohepatitis.html:

In one study, 80% of cats with cholangiohepatitis also had inflammatory bowel disease and 50% also had pancreatitis. Feline anatomy is a little different from that in other species. In the cat, the pancreatic duct, which delivers digestive enzymes to the intestine, opens into the same “pore” as the common bile duct. Both ducts share a “doorway” to the intestine. This means that if bacteria invade the doorway, both the liver and pancreas are at risk for infection.

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Many resources I've come across say that the liver is oftentimes affected in duct obstruction, but Sebastian's liver numbers have always come back okay, so I don't know.

I'm going downstairs now to give him his sub-q fluids. Here's hoping he stays still for me. 

I'm posting from my phone, and it is really late for me. But wanted to take a quick moment to say I'm so glad he's home, eating, keeping food down (!!) ... and eating!

Quick answer to your question, yes, the Chinese med studies on pancreatitis are in humans. None exist in cats, not that I've found.

 I know, right?!   I knew in  the past decade or so, they have been finding out that pancreatitis is more common in cats than used to be thought.    and also that cats often have less overt symptoms .  But  to find signs of pancreatitis in almost half  of the apparently healthy cats!  Wow!      

Maybe it's not really as high as that.    .    In the UC Davis study that found signs of mild p-itis in 45% of apparently healthy cats    (28 of whom were killed for that study -- poor cats. ; those 28 had been lab cats,  they were the control group for a previous study . Living in a lab might be a stressful situation for a cat,  and I wonder how that might have affected them developing pancreatic lesions... . he others in the 'healthy cats' group  were cats who died due to sudden trauma   like being hit by a vehicle but had been reportedly healthy before that ... but if that's just based on owners' statements,  some of them may not have realized the cat was not really healthy ) ,

  In that paper they also mention the pancreas being very sensitive                                 they also found a high percent in cats who had some disorder not involving the abdomen.  The authors wrote:  "This finding might suggests that the pancreas is very sensitive to drugs, stress, metabolic derangements or ischemia associated with a wide variety of clinical conditions. "   

 Here is that article: 

  De ****, Forman et al:  Prevalence and Histopathologic Characteristics of Pancreatitis in Cats .  http://www.idexx.com/pubwebresource...ries/pancreatitis-prevalence-vetpatholv44.pdf  

 That article about TCM  in treating pancreatitsi is interesting , Laurie.    I wonder if that might have helped  Louis.    His health was just so darn complicated ;   and my intro to him having pancreatitis involved him nearly dying of that and diabetic ketoacidosis that had resulted from it ( along with a  UTI and a messed up liver) .   So  I was afraid to try alternatives other than what the internal med specialists recommended. 

@ GoHolistic -- Maybe an abdominal ultrasound would help to give an idea of what is going on in there.

  If it turns out to be intestinal, and you are considering a corticosteroid, what about budesonide?     

Ugh...I opened up a brand new can of the NB Duck & Green Pea this morning for Sebastian and he wouldn't touch it. Same expiration date and everything. He ate it so readily yesterday! This cat is going to make me insane.

The whole pancreatitis thing is such a mystery, among many other feline ailments. Makes me want to go back to school, get a veterinary degree, and obtain funds to do some much needed research.

maewkaew said:

 
 btw here is  another article ,  by vets at Texas A&M's Gastrointestinal Lab, on Chronic Pancreatitis in Dogs and Cats ;                                                                                                                                                                   http://www.2ndchance.info/pancreatitisdogXenoulis2008.pdf

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In the document that maewkaew provided, it mentioned that feline herpes virus and feline calicivirus are suspected to be associated with the development of pancreatitis in cats, although only one confirmed report shows pancreatitis being related to infection with a highly virulent strain of calicivirus. Sebastian has both of these viruses, and he's on l-lysine. Which leads me to another question...I've read here on TCS that l-lysine can cause digestive upset. Do you think it's okay for Sebastian to be on l-lysine? I keep him on a maintenance dose - 500 mg daily divided between AM and PM.

During the first bout of pancreatitis at the end of July, it was much more serious and he was hospitalized for three days. He had x-rays and an ultrasound. The x-rays showed what appeared to be some inflammation and thickening, but an ultrasound was needed to confirm. We had the ultrasound done and it came back unremarkable. I met with the radiologist and she was confident that everything looked okay and the chances of cancer were minimal. I can provide the ultrasound report if you'd like to see it.

GoHolistic said:

...In the document that maewkaew provided, it mentioned that feline herpes virus and feline calicivirus are suspected to be associated with the development of pancreatitis in cats, although only one confirmed report shows pancreatitis being related to infection with a highly virulent strain of calicivirus. Sebastian has both of these viruses, and he's on l-lysine. Which leads me to another question...I've read here on TCS that l-lysine can cause digestive upset. Do you think it's okay for Sebastian to be on l-lysine? I keep him on a maintenance dose - 500 mg daily divided between AM and PM....

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My Chumley had wicked diarrhea from L-lysine. In that instance, the trade-off wasn't worth it. If you want to see if Sebastian's appetite improves, you can take him off the lysine to see. At that point, you have to decide whether his appetite is more important than controlling herpes flare-ups. Though I have been doing research on probiotics, and I'm finding that they can potentially help control herpes too. I wonder if that's why Chumley hasn't had any issues with the herpes? It cleared up and he's had no flares despite having no lysine supplement: and the holistic vet had us put him on a somewhat high dose of human probiotics, just acidophilus and bifidobacterium. (He's been on it for about three years now, and never had a herpes flare-up in all this time. :cross: ).

Thanks, LDG, for the information. The l-lysine never seemed to bother Sebastian in terms of diarrhea. In fact, I can recall only one time he had diarrhea, and that was my fault for giving him a new wet food too quickly. I have since reduced the l-lysine to see if it makes a difference.

Unfortunately, Sebastian wouldn't eat this morning or tonight, so I had to syringe feed him his dinner tonight.    I hate this.

Sebastian is still not eating on his own, even though I've been offering him a smorgasbord of food. I've been having to syringe feed him.    I tried giving him a dose of Cerenia this morning (in tablet form), but it was so stressful for the both of us. He would not swallow the pill, so then it started to dissolve and he started foaming at the mouth and shaking his head. I finally gave up and he ran and hid from me for the rest of the morning...not the kind of experience I want, especially if I have to pill him long-term.

As LDG suggested, I'm going to stop at the drug store on my way home from work and see if I can find some small gel caps. Doc wants me to try to give him mirtazapine tonight.

She also wants me to bring him in again tomorrow and chat with me. 

I'm sorry, I really wish I knew something that might help. Feeding tube, perhaps?

peaches08 said:

I'm sorry, I really wish I knew something that might help. Feeding tube, perhaps?

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It's okay.  I know you have offered all the advice you can at this point. I know what needs to be done next. It's just difficult to try to adjust his diet when he's not eating at all, so I pretty much have to wait until he's back to eating to do anything with that. I'm sure the vet and I will discuss a biopsy (eek) or perhaps another ultrasound. I'm going to deny any future x-rays because they don't seem to be doing us any good. I'd rather just get the ultrasound done and get better information from that. The vet is open, as am I, to a feeding tube if it comes to that.

I never even thought to look for empty gel caps at the store. I buy the small ones, and use these:
I know you most likely want to buy just one pack of 1,000 capsules - but it costs about the same for a pack of one by different manufacturer(s).

More for your boy. :heart2:

LDG said:

I never even thought to look for empty gel caps at the store. I buy the small ones, and use these:
I know you most likely want to buy just one pack of 1,000 capsules - but it costs about the same for a pack of one by different manufacturer(s).

More

for your boy.

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Thanks for sending me the link to the ones you use. This is helpful. I figured since I need them right away, that I would check the drug store first. We'll see.