Help!! Beloved Cat Just Diagnosed with Pancreatitis/Kidney Failure

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iloveprincess

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GoHolistic and Dan32, thank you for the replies and concern about Tigger. I'm finding it frustrating and painful that my friends and family don't seem to empathize with how horrible this is, so it's nice to talk to others that have been or are going through this. It sounds like you both have had different experiences with pred. GoHolistic can you tell me more about pred being  contraindicated in cats? The reason I ask is because the vet is weaning Tigger off the pred. Dan, Tigger's pred is in liquid form, is that the same as the suspension you used? 

What an awful day. The ultrasound revealed Tigger has very aggressive pancreatitis with severe inflammation that has spread. They also picked up nodules and possible cancerous cells, but I am unable to afford a biopsy. The radiologist recommended they hold him there, but the vet knows I can't afford further treatments and felt Tigger would be happier at home, with me. They gave him an enema (he seemed to be quite backed up), which pissed him off, so he had to be sedated for the ultrasound. The vet commented that Tigger's lungs sounded muffled during the check-up, but I was not able to afford an x-ray. so I'm scared that pancreatitis is not all that Tigger is dealing with. The vet felt the pancreatitis had been going on for some time, though :(. He told me he was actually expecting it to be worse, or that they would find a large tumor or cancer. I'm not sure if that's good news or what. So, Tigger is being weaned off the pred, is on antibiotics, fluids, cerena, pain meds, and has an appetite stimulant if necessary. I can't help but wonder if maybe the pred just wasn't high enough for Tigger. Without it, how will the inflammation stop from spreading (if it's not caused by an infection)? I feel like I'm just treating the symptoms, but allowing the problem to grow. 

He ate a bit when he got home, so that was promising. But, despite the sedation effects and pain meds, he is still hiding and appears to be in pain. I'm not feeling optimistic about this at all. As I mentioned, I am an unemployed student and had to dip into my rent money to pay for this. If this doesn't work, I'm afraid I have to let go. I just don't know at what point I stop trying. 
 

goholistic

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My vet told me that pred can be contraindicated in cats with pancreatitis. I thought I read that online, too, but they never really say WHY. That drives me crazy. So, to answer your question...I don't know why pred would be bad for a cat with pancreatitis. The vet didn't start Sebastian on pred right away. We were treating his first bad flare as thought it was an acute case of pancreatitis...meaning it was severe, but a one-time deal. However, he continued to display signs of digestive upset, so we decided to reevaluate and start treating him as though IBD was playing a part in all of this. (I declined a biopsy.) So that is when the doc put him on a novel protein hypoallergenic diet and prednisolone to control inflammation in other parts of his GI tract that could be contributing to the pancreatitis. This is all a guessing game and trial and error. He's due for more tests on Monday. Of course, cancer is still on the table, and only time will tell.

I'm sorry to hear the inflammation has spread and that it is aggressive. 


I know how difficult this is. And it's even more difficult when you don't have the funds to help your cat. Many people have applied for Care Credit, so you could look into that. You're doing the best you can for Tigger. I think you'll know what to do. I would be concerned that he hasn't improved much in 6 days and the fact that he isn't eat much. Cats who aren't getting enough food into their system can develop fatty liver disease.

for you and lots of
for Tigger!
 

dan32

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Biopsies are not always so conclusive anyway, especially if they have already been getting prednisone.  To get a correct biopsy, they want to ween off the pred first.  Kinney had a needle biopsy of his tiny duodenal lymph node, but he was already on pred and it came back inconclusive.  So there was a bunch of money and waiting around for nothing.

Am I reading then that they are going to try antibiotics in place of the prednisone?
 
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iloveprincess

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Thank you, GoHolistic. How is Sebastian doing today? Would you be willing to ask your vet about pred possibly being a contraindication in cats with pancreatitis when you see him/her on Monday? My vet made no mention of this. I'm sorry if you said this, but did Sebastian get an ultrasound, as well? What diet did the vet choose for Sebastian? My vet didn't think I needed to alter Tigger's diet. I'm not saying my vet isn't good, but most of the treatments Tigger is receiving is because I had to bring it up first. Ugh, I feel for you, hun, we are seriously in the same position. It is so stressful and scary not knowing what is really going on with your kitty, and having the threat of cancer hanging over your head makes it even harder to deal with. Hugs and healing vibes back at ya!

I was denied for care credit, but thank you for the suggestion (tough to get a loan without an income). This is pretty much my last resort, I can't afford anything beyond this, which is such a horrible/desperate place to be. 

Dan, I'm very sorry to hear you never really got any conclusive answers to what was going on with Kinney. I'm surprised they would recommend biopsies, knowing the result might be skewed due to the pred. My vet actually told me even if it is cancer, the prognosis is pretty dismal. He told me he had many clients that spent a lot of money on their kitties (biopsies, chemo, etc.), and they still didn't make it. I was happy he was honest and realistic with me.

Yes, you are correct that the vet is replacing antibiotics with the pred.  Based on lab results, it really doesn't look like infection is the cause of his pancreatitis, though, so I can't help but question this protocol. The vet said they would call today to check on Tigger's status, but never did, so I feel like I'm kind of on my own at this point. 

Tigger seems a bit better today. It could be because of the pain meds or the appetite stimulant, but he is eating small meals. He still seems to be in some pain though, as he can't really lay comfortably. For anyone else who has a cat on buprenorphine, does your cat have huge pupils and sort of have difficulty relaxing? The vet told me the med would make him sedated, but he seems to experiencing the opposite, like he can't sleep. He just has this agitated/dazed look on his face. I wouldn' t say he has seen no improvement in 6 days. He seemed to be getting better, but then suddenly got worse over the course of a day. This is such an emotional roller-coaster!
 

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If the appetite stimulant is Mirtazapine, that could explain his dilated pupils, etc.  Mirt is an anti-depressant in humans which has an appetite stimulant effect in felines.  It made my guys crazy for days at a time, so I favor the other appetite stimulant - Cyproheptadine, instead.  Cypro is an old line antihistamine which at most only made Kinney a little sniffly, but not cuckoo.  Vets seem to like one or the other.

I was reading up on pancreatitis since lymphoma, although related is not the same illness.  I was surprised at how complicated it is to treat.

http://www.2ndchance.info/pancreatitiscat.htm

The 2ndchance website mentions about the use of pred, when it is contraindicated and how sometimes antibiotics work instead.  I may be all wet, but since the pancreas regulates glucose, it would seem to me that cutting back on carbs (kibble) would give it a rest.

Also, I had wanted to ask if you are doing anything for the kidney disease other than the renal support medicine?  The website also mentioned the use of sub-Q fluids, which I know GoHolistic is giving on a frequent basis.
 
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iloveprincess

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Thank, Dan, for the replies and article. I just wanted to say your posts are very helpful and you are a valuable resource on this forum. It would be easy to stop replying to folks when you aren't currently dealing with a sick kitty, so I'm very thankful for your presence here. 

I just checked and Tigger IS on mirtazapine. I would have never made a connection to his strange behavior and this drug. I will have to see if I can continue to get him to eat without this medication. 

Yeah, I have been giving Tigger sub-q fluids daily (per my suggestion to the vet). He seems to actually enjoy getting them. I also have him on b12 shots once per week. 

Okay, I feel better about the antibiotic approach. I just reread that article you originally posted from innex. They also don't necessarily assume pred is the go-to treatment for pancreatitis. Fingers crossed here!!!!
 

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Yes, if the appetite stimulant is mirtazapine, then it can make him restless. The benefit of mirt is that it is only given every 3 days. Continue to offer Tigger small, frequent meals if that if what he prefers. Offer different kinds of foods - wet, dry, even 100% meat baby foods (no onions or garlic!). I can't stress enough that he needs to eat or else he can go into liver failure. If his gums are starting to yellow (jaundice), that means it is already starting. I don't mean to scare you, but I did have to syringe-feed Sebastian for almost a week after he was brought home from the hospital that time in July.

Take a look at this document by Idexx Laboratories: http://www.idexx.com/pubwebresource...pec-fpl-treatment-for-feline-pancreatitis.pdf

It was a big help to me in understanding how to treat pancreatitis, which is basically just supportive. In looking at the document above, it says that the use of steroids is NOT contraindicated and can actually be quite helpful. The opinion on this probably varies vet to vet. But seeing that Sebastian is now on prednisolone, I suppose my vet decided it would do more good than harm at this point.

My vet followed the Idexx protocol to a T. Sebastian had multiple blood labs, multiple x-rays. He was hospitalized overnight for several days. Very expensive on my part, but I really think he got better much faster in their care. Fluids are extremely important. He was put on an IV, got Pepcid AC daily (for acid reduction, which can help reduce nausea), Cerenia daily (another anti-nausea which also has anti-inflammatory effects), Metronidazole (a GI antibiotic that has anti-inflammatory properties), and the Fentanyl patch (for pain; lasts for 3 days). They monitored his liver enzymes (elevated enzymes are indicative of fatty liver disease). I started to get nervous after 72 hours, as he still hadn't eaten. By day 4, I took him to the specialist for an ultrasound. The x-ray he had showed thickening of his pancreas, and his abdomen was hard and distended. However, by the time he had the ultrasound, it was "unremarkable," meaning it didn't show anything abnormal. So either the inflammation went down by the time of the ultrasound, or the thickening wasn't pronounced enough to be picked up. He's probably due for another ultrasound soon to check for any permanent damage. I still give fluids to Sebastian at home at least every other day. This past week it has been every day.

There is a more accurate test for pancreatitis called the spec fPL test. It needs to be sent out to Texas A&M. Sebastian is having this done on Monday to check for chronic pancreatitis.

Sebastian is doing great tonight. I gave him mirtazapine last night, and it really helped his appetite and activity level.

Continued vibes for Tigger! I hope he turns a corner soon! 
 

goholistic

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Oh, and I also wanted to piggy-back off of Dan32's comment about the renal support. The only reason I am only commenting on the pancreatitis is because that is what I have experience with. I suppose we can't forget that Tigger has kidney failure, too. Kidney failure can cause a whole set of problems depending on how progressed it is. From what I read, it seems that is the lesser of the two evils right now.
 

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I read through this thread and I am sorry for what you are going through.  I have a cat with chronic digestive problems that had the serious flares with hospitalizations for 6 years before I found a vet that knew how to treat him.  His last flare involved his liver two types of hepatitis one of them being fatty liver.  The way I am understanding it now is your vet is tapering him off of pred and putting him on antibiotics.  My cat was put on antibiotics for his flares before his last major one, he is on a permanent low dose of a steroid now.  The antibiotic that was used was metro which also has an anti-inflammatory effect.  He would come out of those flares after several days but then have another one.  The vet that I took him to with his last major flare had him on both the prednisolone and the metro.  I guess I am just not understanding this either/or approach, it can be both.  Patches was on 10 mg of prednisolone in addition to the metro then several weeks after his symptoms had subsided he went to 5 mg of prednisolone a day.

I wouldn't jump to the conclusion that there may be cancer from the ultrasound results.  The spread of inflammation is very common and is due to the way the cats digestive system is.  The openings for the liver, pancreas, and intestines is right there together so it is very common for the inflammation to spread.  Some cats get a condition call triaditis(sp) which is inflammation of the liver, pancreas, and intestines.
 

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Good point, Denice. Sebastian has also been on the Metro and Pred at the same time, and the vet will still prescribed the Metro if she suspects another flare in Sebastian (while he continues to take the Pred).
 
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iloveprincess

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I just checked his gums, they are pink/black. Yes, I am very afraid of fatty liver, so I'm doing everything I can to get food in him. He was doing pretty good with eating, but is turning food away now, which just makes me feel so helpless and stressed out. 

Oops, I wrote Innex above, but meant to say Idexx. Yes, I have read their article, which is very informative. Tigger had the fPLI test already. The normal range is 0-3, his level is 50 (50 being the highest the test reads). I was shocked, considering the only symptoms were intermittent vomiting of hair balls and a slightly decreased appetite. 

Yeah, I almost wonder if the kidney failure is a result of the pancreatitis. He had his kidney levels checked about 3 months ago, and since changing his diet, his levels have only gotten slightly worse. So, it seems the kideny issue is secondary to the pancreatitis. 

Holistic, it sounds like you have a wonderful vet who is on top of things. The more I listen to you guys, the more I doubt my current vet. If I was not proactive about Tigger's treatment, he would not have recommended sub-q fluids, an appetite stimulant, B12, pain meds, or cerenia, that was only a result of my suggestion/insistence. Unfortunately, I don't have a car, though, and his office is conveniently located and slightly less expensive than the others around. I also am concerned with the either/or approach. I want to make sure I'm doing EVERYTHING I can for Tigger. I am contemplating going against his advice and continuing with the 10mg of pred. I was afraid of the side effects of pred, so I wonder if that's why the vet is weaning him off. Tigger is on Orbax, not metro, which sounds to be far more appropriate of the two. Ugh, what the heck!! 
 

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Sebastian's gums are black, too, because he's a black cat, so it's hard to tell. You can also check the ears.

I'm not really sure if kidney disease and pancreatitis somehow tie into one another, so I can't really comment on that.  


I'm so sorry that you doubt your vet. Unfortunately, we can't offer medical advice here. We can only share our experiences with our pets and vets. I would suggest to get a second opinion, but I guess that is not an option for you. Is there another doctor at the practice that you could talk to? Did you have a conversation with the doctor about the pred vs. antibiotic vs. both?

I'm not familiar with Orbax. My experience has been that Metronidazole is the antibiotic of choice for GI issues.

I truly understand your frustration and worry.
 

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The main side effect with steroids, and that's with long term use, is diabetes.  Cats actually tolerate steroids better than people do.  With the pancreas involvement I can understand not wanting to use steroids long term because the pancreas being damaged would also increase the risk of diabetes.  I know a lot of people use digestive enzymes for a cat with a compromised pancreas.  The pancreas may not be able to produce enough enzymes.

A lot of us with a cat that has these types of digestive issues don't have a definitive diagnoses.  Actually I think a definitive diagnoses is rare.  Kidney function is much easier to measure, it's a matter of the numbers on a lab test.  I don't think there is a connection between the digestive issues and loss of kidney function.  I have heard that all cats over the age of 10 have some loss of kidney function it's just a matter of rather they lose enough function to go into CRF and then there are degrees of CRF.  Change of diet will slow the progression.  I think CRF is caused by a combination of genetics and diet.  Don't beat yourself up about what you were feeding before we all can only do what we know to do.  I think a diet of mainly dry kibble increasing the risk of CRF and a lot of vets still think there is no difference between dry and wet and some even think a dry diet is better.
 
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iloveprincess

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Tigger seems to be a bit better today. He actually meowed and told me it was time to eat this morning, so that made me extremely happy. He seems more comfortable and more alert. Fingers crossed!!!

Thanks for the tip regarding checking their ears for jaundice. I am checking regularly. 

Yeah, I'm not sure why I feel the pancreas and liver are related.  I guess because when he first started showing signs of pancreatitis (the vomiting), his kidneys also started to fail. Who knows, maybe it's just a coincidence. I do believe I read that pancreatitis left unchecked can damage all other organs, including the brain.

I believe cats have also experienced sudden heart failure on pred. Somewhere on this forum (I think), I read someone warning others that their cat died soon after starting pred. He had also known someone whose cat had a stroke on pred. Hard to say if it was the pred or another preexisting condition. I brought up the possibility of enzymes to my vet. He felt Tigger was on too many medications as it is, and didn't recommend them. I've also read that enzymes can either help or make things worse, the same as probiotics. 

Yeah, it really surprises me that vets still endorse feeding kibble. I wonder if some know the dangers, but don't advise against it since the associated health risks bring in a lot more business for them. I really hope that's not the case, that would be very disappointing. Thanks for the reminder about not beating myself up about their crappy diet in the past. it's hard not to when I feel like that is a big reason we are where we are right now. I wish I had been more educated in the past, but at least  I know better now. 
 

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That's great about eating - eating is everything!  If Tigger co-operates maybe you can make some smll changes to his diet.  Many people here swear raw diets solve a lot of medical issues.  Yet my guys have not been easy converts either.
 

maureen brad

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I would suggest switching to Natural Balance Limited Ingredients. It is grain free and much easier to digest. Kitties with pancreatitis have a hard time digesting foods and the fewer ingredients the better.My cat had pancreatitis and developed jaundice/kidney failure. He had to be syringed fed . A month into it I found that he should have bee prescribed an appetite stimulant to avoid anorexia. Those stimulants are risky for the liver we tried it out of my desperation butt the vet made a dosage mistake and Ziggy seized. The appetite stimulants initially worked within 20 minutes. I  wish I had known about them sooner.My vet never suggested B-12. He never suggested anything more than sub-q fluids9if you aren't doing that I would suggest it, its easy to do, not expensive and helps so much) my vet was terrible.I have since switched vets.For my cat due to many factors it was to late. I originally didn't notice he was sick because he had needed to lose weight and I switched his food . When I noticed he was losing weight I didn't think he was sick. His coat looked good etc. Then he threw-up a couple times so I started really watching, that's when I noticed he wasn't eating and we went from there. I sounds like you are being very vigilant and also sounds you have a vet who is on top of it. That makes so much difference. Good luck to you and your kitty.
 
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iloveprincess

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Thanks for the suggestions, guys. Tigger has been switched to Honest Kitchen (which is supposed to be dehydrated raw). I just realized it has a really high fat content, though, so I'm not sure if I will keep him on it. He is currently being fed Nature's Variety instinct, duck formula. I looked at Natural Balance and want to avoid any canned food that has carrageenan in it, which NB has. 

Maureen, I'm so sorry to hear you caught things too late with your kitty. That must be devastating :(. Please don't blame yourself, cats are masters of hiding these things.

Today Tigger seems to be doing awesome! There were a few really promising behaviors. One was when he all of a sudden stood up in the middle of the night. I thought, oh no, he is about to puke. Instead, he started "making biscuits" on his blanket :). He also has been eating like a little piggy and has been purring and talking up a storm. He even came over and snuggled with me (like his typical sweet self). He is almost out of his pain meds, so I really hope he is well enough to not need them (or I pray he doesn't relapse). Fingers crossed!!!!
 
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mrsgreenjeens

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High fat is good for kidney cats, but I don't know about pancreatic cats.  But it sounds like he's feeling good
.  Glad he appears to like the Honest Kitchen.  I don't know of many cats who do, but then again, the only cats I know of who've tried it were eating actual raw, and tried this as another form of raw.  Doesn't quite seem the same as real meat, although it's probably better than a lot of canned foods
 

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I am SO glad to hear that Tigger seems to be improving!  I was really, really worried. 

I really do hope that Tigger's pancreatitis was only a on-time, acute episode. 


Continued vibes! 
 
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