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

I do think pred works that quickly, actually. You can sure try upping the pred on the weekends to make up for the lack of cerenia, and see how it goes! :bigthumb:

And I have been of the opinion for a long time that while cats definitely have food preferences, and some cats (like mine) get bored of the same food (so I have a set rotation), not eating a food you know they've liked is a sign of a problem with kitty and how they feel. :heart2: :rub:

SO glad the upped pred helped!

FYI, the main issue with pred and cats is the potential for diabetes. But I *believe* this is because of how pred affects glucose levels. So if feeding a kitty a species-appropriate diet, I think that lowers the risk of that potential problem. I keep Lazlo on 5mg of pred because of his prior cancer, and my vets are not concerned about his developing diabetes. :dk:

Also, Tuxedo was on pred for a year (while eating kibble), and then depomedrol (the highest dose possible) for MANY years, though the dose was slowly lowered (autoimmune disease that caused anemia, so it was an immune-suppressive dose, not an anti-inflammatory dose). He was tapered off to almost none by the time we started feeding a species- appropriate diet. I guess we were fortunate that he didn't develop diabetes.

Personally, I think that as diabetes can be managed (especially by someone that pays so much attention to detail like you!), I wouldn't worry so much about the pred if it makes him feel better.

Of course... I still think a raw diet may resolve many of these issues, and reduce his needs for many of the meds. But he's not three, so there's just no way to know how advanced the problems already are.

I think too that just as in people the predisposition to diabetes has a genetic link.  Patches has been on a steroid for 3 years and the little kibble addict is still getting half of his food in the form of kibble, so far no diabetes.  I have heard of cats here that have developed diabetes with much less time on a steroid, every time I see one of those here a little alarm bell goes off in my head.  I remember what it was like when he would get so sick and I ignore the alarm bell.

Thanks! I'll def talk to the vet about upping the pred on the weekends and see what she says.

About the diabetes...do sub-q fluids, by any chance, "curb" the development of diabetes?  I'm probably giving fluids more regularly than most people do (if at all) for cats with these same issues, so I'm not sure if there are any case studies or data there.

About the species-appropriate diet...I'm willing to try this again, maybe not even with cooked rabbit, but with the raw rabbit. However, if I keep seeing a trend of him not feeling well after giving it, I'm not sure how much I'm going to push it. He seems to do well when I leave everything alone. Again, I'm not against a species-appropriate diet. I am willing to do what works best for Sebastian, and makes him feel better.

No, fluids would not impact steroids and potential diabetes. I agree with Denice, there appears to be a genetic component. But Tammy's experience (Momto4kitties) CLEARLY indicates that the main issue with steroids is how they impact blood glucose levels. When Lucas is on a diet with carbs, he now has diabetes. When she lowers the carbs, his blood sugar levels are normal - and Lucas cannot go without steroids because of his discoid lupus. It is a very fine balancing act. :heart2:

My dad was a type 1 diabetic, and steroids were always used as a last resort, because when he'd take steroids, his blood sugar levels would whack out.

If Patches develops diabetes I will definitely make another try at getting him completely off the kibble.  I am hoping things continue as they have.  

LDG said:

No, fluids would not impact steroids and potential diabetes.

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Bummer. 

Denice said:

 
If Patches develops diabetes I will definitely make another try at getting him completely off the kibble.  I am hoping things continue as they have.  

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I hope Patches continues to do well, too! 

I have been doing a lot of research on this as my vet wants DeeJay on it long term.  This is what I have found.  The dose of prednisone usually takes effect pretty quick, it lasts for about 1-2 days.  To minimize the risk of diabetes oftentimes it is normally given at an every other day or every 3rd day dosing (long term you want the cat on as low of a dose as possible as less often as possible) as it keeps the body's own cortisone reserves healthy.  It should be given with food and it should be given at night if it's a once daily dosing as that corresponds to the kitties natural hormone cycle.   Usually cats who are going to get diabetes from steroids are genetically disposed to it, overweight or on high carbohydrate diets.  I found this article interesting (has a lot of good links in the foot notes) http://endocrinevet.blogspot.com/2013/01/steroid-induced-diabetes-in-cats.html   While sub q fluids may help flush the system, I do not think they would have any effect on whether or not the cat gets diabetes.  I have seen steroid induced diabetes be reversed, but that isn't always the case.

GoHolistic, just wondering how Sebastian is doing? Xx

Thank you for asking about Sebastian.    I was going to wait until January 22 to post an update, but we're close enough.     That day marks 6 MONTHS since his first pancreatitis attack in July 2013. I am so grateful that my sweet boy is still with me.

Overall, he is doing well. He has some mild "off" times on occasion, but this is expected. In all reality, he hasn't had a serious flare since October. There are certainly more good days than bad, so I am very thankful for that. About 2-3 weeks ago, I slowly switched his fish oil brand to one that has a higher concentration of EPA and DHA. I've looked at so many brands and found that you need to dump a huge pool of oil in the food to get any significant omega benefit. He won't eat oily food, and I wouldn't want to either. With the new fish oil, he only needs 1/4 tsp daily, which I divide among his morning segmented feedings. He likes it in his food and seems to be doing well since starting it. This is the only change I've made.

He vomited once last week and seemed a little off the next day. My boyfriend asked, "What did you change?" and I so confidently replied, "Nothing changed!" But something had changed. I hadn't been able to get to the vet to pick up his fluids since I've been working late, so we were going on day 4 without fluids when he normally gets them every 2 days. As soon as I started the fluids back up, he felt great again. I think the fluids really do help more than I initially thought, and it looks like they will continue long term.

For those just tuning in or want a recap, here is his current regime, monitored closely by our vet:

(I didn't provide dosage amounts for the prescription meds because I wasn't sure if it violates forum rules.     )
He continues to eat Royal Canin Veterinary Diet Hypoallergenic Selected Protein PR (rabbit) food. Per day, he eats one whole 5.5 oz. can of wet food, sometimes a little more (like another 1/8-1/4 of a can), plus 1/8 cup of dry. I feed him in 1/8 can increments to prevent regurgitation, but as it turns out, he actually eats more when I do it this way.    Then he has a good fast in between meals to let his system rest.

My next goal is to talk to the vet about reducing the Metro. I still conduct a lot of research on what alternative treatments I can add to his regime, but many of them don't have enough studies, success stories or a definitive "yes, this works" to warrant the risk of changing things and having him flare up...in my opinion.

So, there we are.    In the picture: Sebastian is sleeping comfortably and looking "fat 'n' happy." His belly fur is finally starting to grow in. It takes forever!

What a sweet kitty! I'm so glad he's doing
well

Such a good update, so glad to hear he is doing well.  That is interesting about the subq fluids, maybe I need to talk to my vet about adding them in for DeeJay.

GoHolistic, just checking on Sebastian. I've been sick and fell behind. I'm glad that he's still doing well. He looks so much like my Munchkin! He looks happy and hopefully the worst is over for a long, long time!

I'm so glad Sebastian has not had a serious flare in months!!! Perhaps he just had the acute and not chronic form of  pancreatitis (Tigger's is chronic)? Do you feel the fish oil has helped with the inflammation? Have you tried slippery elm? When was Sebastian's belly shaved? Tigger's belly was shaved in October, but the fur has already all grown back...

I hope of course 'all the best' for Sebastian. Like Mr Micawbar Always said: "There is Always a possibility!"

That's great! It sounds like you have a daily health regime down. My vet told me that most of the time it's just finding out what works and sticking with it.

Hope I'm not jinxing anything by saying "way to go, Sebastian!" (and to YOU, of course, for doing all of this for him )

It's nice you've finally found something that appears to be working well. 

GoHolistic said:

For those just tuning in or want a recap, here is his current regime, monitored closely by our vet:
(I didn't provide dosage amounts for the prescription meds because I wasn't sure if it violates forum rules.  

  )

Prednisolone	Standard dose	once daily
Metronidazole (Flagyl)	Low dose	twice daily
Maropitant citrate (Cerenia)	Low dose	Monday through Friday only
Famotidine (Pepcid AC)	1/4 tablet	twice daily
Fish oil (from sardines, anchovies)	1/4 tsp (EPA 184 mg, DHA 112 mg)	once daily
Probiotics, 10-strain	17.5 billion CFUs	once daily
Saccharomyces boulardii	2.5 billion CFUs	divided between AM and PM
Subcutaneous fluids	100 ml	every 2 days
Purified water by reverse osmosis
Coconut oil, organic extra virgin	1/4-1/2 tsp	daily

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For some reason, I cannot edit my post, so I am quoting myself with an edit.

I forgot to add the coconut oil to his regime chart. He gets about 1/4-1/2 teaspoon organic extra virgin coconut oil daily.

Thank you...EVERYONE! 

@cprcheetah, yes, definitely talk to your vet about fluids for DeeJay. They might help with a few of her issues (bladder/urinary, constipation) and help keep her system flushed. Although I can find no studies on this, it seems fluids have a positive affect on Sebastian's GI inflammatory issues. (However, caution must be made with administering fluids to cats with heart/cardiovascular conditions and other conditions that could cause or exacerbate fluid accumulation in the chest cavity or lungs, such as cancer and FIP.)

I'm sorry to hear you were sick, @Roxie. I hope you are all better now.

@iLovePrincess, it is my understanding that the acute form happens once or twice, and that the chronic form can develop after a few acute attacks. Sebastian had three fairly serious flare-ups in 2013 (July, September, and October). In October, the spec fPL showed mild pancreatitis, which tells us the pancreatitis is always there and wavers in severity. I'd like to think that the fish oil is helping because he's been feeling great since starting him on the new one, but I can't really say for sure how much it is helping with the inflammation. I have tried Slippery Elm Bark. I was giving it to him during his October flare for about 4-5 days straight. Unfortunately, it didn't seem to make much of a difference and I was only stressing him out by syringing it into his mouth. He was still sick while administering the SEB and remained sick a week after giving it to him. I do think it helps coat the stomach and aids in acid indigestion because I give it to Caesar for this purpose, but I'm not sure of its effectiveness with inflammation if it is already bad enough. I think it was October that Sebastian's belly was shaved, but it might have been November. I don't have his chart with me right now. 

I was worried about updating this thread because it seems I often jinx myself.    I do think that, like people, treatments and their effectiveness will vary from cat to cat. It's quite a journey to get to a place that works (even if only temporary).

:cross: ...but and !!!!!

Which fish oil supplement are you using? Mine really aren't in love with salmon oil, but *most* of them like sardines....

Boy, that is a lot of regimen!  Kudos to you.

What ever happened with the rabbit?  Did I miss that?  We are just finally finishing up a 4#  bag of NV Rabbit from mid-summer and I don't plan on restocking it.

btw: my Mom is giving their dog coconut oil now.  I was telling her about it's popularity here on tcs.