Post-pancreatitis - how to get him back to his old weight?

Status
Not open for further replies.

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
This may be long so thank you in advance for reading.

We have two great cats from the same litter - regular domestic short hair/medium hair. They've been with us since they were 3-4 months old, brother and sister. Now 8 years old. No real issues in prior years - they had check ups every six months at Banfield, teeth cleaned once a year and rinse/repeat until we moved overseas with my job in 2011.

In the past year or so the boy, Tommy, my beautiful tuxedo, would throw up after eating food on occasion and in the last 6-8 months it turned to be daily. We're talking light brown vomit and on occasion getting darker but we thought it was from the food or eating it up too fast. When we were back home in the US in December 2013 we took both cats to the vet for dental cleaning, blood work and mentioned this but they said there's nothing wrong. We were in West Africa before and Tommy or Sally didn't need a vet in the entire two years we spent there - they were both perfect - indoors only cats.

We arrived to my new duty station in the middle east and not even a month into the stay, Tommy starts losing weight. He was at healthy 13.4 lbs when we got here and went to 12.4 lbs in a month or so. More throwing up of the dark brown kind. I naturally call a local vet to do a house call - according to her it's probably nothing, adjustment to new environment, stress - gives him an antibiotic shot and a vitamin shot and he perks up. A week later back to the same - losing weight, won't eat, when he does eat throws up - same thing with vet antibiotics and he'll be fine. I was probing at that time if more could be happening but told nothing. Another 4 days later and he is still losing weight - more antibiotics and this time I want blood work done and x-ray - not needed. Three days later he is worse - I get the vet to come again and this time demand blood work and x-rays - she finally admits she has no idea what's going on with him but she has a friend who has a vet clinic and to take him there. Tommy is now at 10 lbs! We take him to the vet and leave him so they can run the tests and do the x-ray and the vet calls me after 11 pm saying it's pancreatitis and he'll keep him for a week. Finally a relief as I felt we were only masking the symptoms and not getting to the cause of the issue. Tommy was well cared for in the clinic and we got to visit pretty much every day and he was so happy to see us. After a week his blood work was back to normal and he was allowed to come back home with us but only instructions we were given is have him eat, continue antibiotics for five days and then start with appetite enhancers (children's syrup, 0.5 ml dosage after each meal).

Well, the eating part was not going so well - I'd offer three kinds of foods, including raw chicken and he'd lick some and walk away. I'd chop the chicken as finely as I could and then he's eat a tablespoon and that was it. A friend told me get yogurt and mix in some sugar and give him that - he'd eat a half a teaspoon and only if I slathered it on his mouth.  I finally started googling all and came up to this forum and realized oh sh!t! he should've been force fed! So husband and I started doing that and there is some progress - Tommy is being force fed and not minding it so much - he seems better but I know we have a long way to getting him back to his pre-sickness weight. He will eat a bit of sour cream as well. Drinks water regularly (bottled one, we can't use tap water here).

Current diet - wellness chicken cans (they may have some liver in them), with a bit of warm water mixed and into syringe (real feeding syringes and cat sack on their way here as I just ordered them). Fancy feast classic (various) on the way here too as he likes those. 

I also got him the B12 shots and have so far given him one and am considering continuing with shots every week.

Questions for you - is what we are doing the right course of treatment? Do I need to add anything else to his diet? How long until I get my baby back to his healthy self?
 

goholistic

TCS Member
Top Cat
Joined
Feb 27, 2013
Messages
3,306
Purraise
370
Location
Northeast USA
Hi there. I'm so sorry about your boy Tommy. My Sebastian has chronic pancreatitis and his vomit is exactly as you describe. His was diagnosed with the spec fPL blood test sent out to Texas A&M as well as an ultrasound. X-rays are not the best sources of information for some conditions, but it seems your resources are somewhat limited where you are.

If it is, in fact, pancreatitis, here's a good document from Idexx that explains how it is treated: https://www.idexx.com/pdf/en_us/sma...pec-fpl-treatment-for-feline-pancreatitis.pdf. Unfortunately, the exact causes of pancreatitis are unknown, so the best thing we can do is supportive care. With Sebastian's first pancreatitis attack, he was hospitalized and put on an IV, as well as an antacid, antiemetic, antibiotic, and pain meds. Pancreatitis is painful. We tried an appetite stimulant after a few days since he still wasn't eating. It didn't do much since he was still quite nauseous and in pain. After four days, I brought him home and had to syringe-feed him for two weeks to make up for whatever he didn't eat on his own (which wasn't much). Two months later, he showed symptoms again. We decided to put him on a oral steroid to keep the inflammation under control.

The four months after the first attack were a rollercoaster. Lots of ups and downs. Eating and not eating. It's really important to keep tabs on how much Tommy is eating. You wouldn't want him to develop a condition called hepatic lipidosis (fatty liver disease) on top of the pancreatitis. It seems like he's already a lot of weight in a short period of time, so I would already be concerned about his liver. Have you checked his gums and ears for yellowing (jaundice)?

Given how long this has been going on, it's possible that Tommy could have chronic pancreatitis (vs. the acute type). You may need to have a "care package", if you will, of things to support him during flare-ups. Although Sebastian's threads are really long, you're welcome to peruse for information:

http://www.thecatsite.com/t/262314/sebastian-hospitalized-has-pancreatitis-seeking-input

http://www.thecatsite.com/t/264363/sebastian-is-back-at-the-vet-suspected-pancreatitis-again

Sebastian's current treatment protocol is provided in post # 627 of the second link.
 
  • Thread Starter Thread Starter
  • #3

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
Hi GoHolistic,

thank you so much for your response - I bookmarked your reference article and will be poring over it in detail today.

I went to your post in the second link - that's quite a list of medications you're giving Sebastian - could you expand on dosages/administration times?

I'd go with double the list if it means my baby is back to health.

As I learned yesterday, I have no issues giving Tommy a shot (after watching youtube videos and reading up on it). Pharmacies here will sell you anything (antibiotics included) so I think I can get the drugs and supplements on your list in consultation with our local vet and the US one. We also have a vet I consulted with over email in Tel Aviv (and was ready to take my cat there) who is Canadian and had a full clinic so if need be we will make the journey there.
 
For inquiring minds, here is what is currently keeping Sebastian stable (and, yes, he gets ALL of this!).  
   He continues to do well. 


Medications/Supplements

Prednisolone

Cerenia

Pepcid

S. Boulardii

Probiotics

Quercetin

Chinese meds

Fish oil

L-lysine

Coconut oil

B12 injections

Sub-q fluids

RO purified water

(Metronidazole and buprenorphine are only considered for more severe pancreatitis flares)

Diet

Single protein rotation every three weeks

Focusing on “cooling” or “neutral” proteins based on TCM consult and diagnosis

Gets high quality canned and home-cooked only (supplemented with Balance It)

No dry food

My journey with the protein rotation is here: http://www.thecatsite.com/t/274500/best-rotation-to-prevent-food-allergies

Mental Health

Low stress environment

Lots of love and encouragement

Play time

Feliway

Bach's Rescue Remedy for Pets (as needed)

I have used Jackson Galaxy's Spirit Essences in the past

I gave this list to our traditional vet so she could update their records. She has no qualms with any of it except the protein rotation, but she's fine with it as long as he's doing well and that I have some novel proteins in "reserve" to fall back on. I am also scheduling a follow-up with the TCM vet to go over everything and ask questions.
I am continuing with syringe feeding - after last night's feeding he ate a tablespoon of his favorite tuna (in the water) on his own - no prompting needed and then some cat treats. My husband will feed him again every 2.5 hrs until I am home from work.
 
  • Thread Starter Thread Starter
  • #5

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
 
How is he doing now?
Tommy had three feedings today (10 ml total this morning, 10 ml around lunch time and 15ml two hours ago) - one more coming up in an hour. The total so far makes it at around 60% food  he'd normally be eating but we're aiming to get it to his pre-illness 100%. He does go pee but even when we're stalking the litter box we haven't seen him poop. He did poop at the vet so I have concerns why isn't he pooping now - not enough food in his system?

On the onset of the pancreatitis my husband caught him licking litter (we have fresh step clumping) - we had it changed out to some German wood chips litter but neither cat seems fond of it (the other goes out to the balcony where we moved the fresh step litter). Kind of stumped why he'd do that as he is not a kitten. Today when he was at the balcony listening to birds outside he licked the walls of the balcony - we get sand on occasion (surrounded by a desert) and I do vacuum the balconies as well but never thought of vacuuming balcony walls.  Is he missing any other minerals?

We are taking him to the vet for a checkup tomorrow after work (they're open from late afternoon well into the night) and I'll be discussing any need for additional nutrients/drugs to be given to Tommy.  I already ordered cat probiotics proviable and viyo recup for cats.
 

dr kris

TCS Member
Guest Expert
Joined
Apr 18, 2014
Messages
75
Purraise
23
One perspective to help you out - pancreatitis can be painful. Now, they won't vocalize, or even change their posture or any obvious outward change, but sometimes it's amazing what simple therapy for abdominal pain will do for them. Viscereal pain can suppress their appetite. Whenever I have a pancreatitis kitty that is stable, at home, but won't eat or won't gain weight, therapy for pain is something I always do. Buprenorphine would be a common medication for this. I think it atleast should always be considered when uravelling the multitude of reasons of why these little guys wont eat sometimes!

hope that helps,

k
 

goholistic

TCS Member
Top Cat
Joined
Feb 27, 2013
Messages
3,306
Purraise
370
Location
Northeast USA
I went to your post in the second link - that's quite a list of medications you're giving Sebastian - could you expand on dosages/administration times?
I'd go with double the list if it means my baby is back to health.

As I learned yesterday, I have no issues giving Tommy a shot (after watching youtube videos and reading up on it). Pharmacies here will sell you anything (antibiotics included) so I think I can get the drugs and supplements on your list in consultation with our local vet and the US one. We also have a vet I consulted with over email in Tel Aviv (and was ready to take my cat there) who is Canadian and had a full clinic so if need be we will make the journey there.
Great news that he ate a little of something on his own!

Prednisolone (a steroid) and Cerenia (an antiemetic) are prescription medicines, so you would have to discuss these with your vet. We did not jump into a steroid right away with Sebastian. Although cats handle them rather well, there are side effects, such as diabetes and glaucoma, so be aware of the risks. If you wanted to consider pain management with a medicine such as buprenorphine, you'd have to discuss this with your vet, as well. The sub-q fluids at home really help Sebastian. This is also a vet thing.

The quercetin and Chinese herbs were prescribed by a Traditional Chinese Medicine (TCM) vet, so you would have to be in contact with a holistic/TCM vet to discuss these types of alternative treatments. Just because something is natural doesn't mean it is safe and doesn't have side effects.

Sebastian gets 1/4 tablet of Pepcid AC Original Strength for discomfort related to excess stomach acid. To maintain Sebastian's healthy gut flora, I give him 2.5 billion CFUs of s. boulardii daily, divided between AM and PM, along with a human grade probiotic at night. I'm still not completely satisfied with a probiotic right now, but I'm currently using RenewLife brand. Other TCS members use a product called Nexabiotic, which has both the s. boulardii and probiotics (an all-in-one option). The Proviable you purchased is a pet-specific product and is fine to use, but you may want to consider a human grade version with few fillers once the Proviable is used up. The fish oil is for omega-3s, which have anti-inflammatory properties. I'm still trying to find a fish oil I am happy with, as well, but I always make sure it has a decent amount of EPA and DHA and no fillers, flavorings, or preservatives. I use Nutiva organic coconut oil to coat Sebastian's gel caps (which have all his meds stuffed into them). You are already doing B12 shots, which is great.

Do discuss all of this with your vet. I'm sorry I can't give you any more information than this. I have to careful about what I say regarding dosages because it violates forum rules.
 
On the onset of the pancreatitis my husband caught him licking litter (we have fresh step clumping) - we had it changed out to some German wood chips litter but neither cat seems fond of it (the other goes out to the balcony where we moved the fresh step litter). Kind of stumped why he'd do that as he is not a kitten. Today when he was at the balcony listening to birds outside he licked the walls of the balcony - we get sand on occasion (surrounded by a desert) and I do vacuum the balconies as well but never thought of vacuuming balcony walls.  Is he missing any other minerals?
Hmm...licking the clay litter as well as the balcony walls sounds like a form of PICA that could be a sign of anemia. I'm not trying to sound like an alarmist, but this is worth telling your vet about. It might be a good idea to have some blood work done and just making sure his numbers are okay.
 
  • Thread Starter Thread Starter
  • #8

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
Thank you everyone!

I will definitely raise all these issues when we go to the vet today with Tommy. I did mention litter licking to both vets we worked with here, I guess I just have to be real persistent with them to get them to acknowledge the issue and come up with reasonable solutions.
 
  • Thread Starter Thread Starter
  • #10

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
Back from the vet - he ran blood work again as well as x-rays. High amylase, high WBC, high Asomething. Keeping him for another 5 days. When his blood work normalizes somewhat he is taking him to a nearby town for CT scan - hope it's not cancer.

Poor Tommy, I hate seeing him suffer.

We can go to visit on Saturday (they don't open for visitors on Fridays).
 

goholistic

TCS Member
Top Cat
Joined
Feb 27, 2013
Messages
3,306
Purraise
370
Location
Northeast USA
Rajiakitty, I responded in the new thread you started about Bisou.
 
Back from the vet - he ran blood work again as well as x-rays. High amylase, high WBC, high Asomething. Keeping him for another 5 days. When his blood work normalizes somewhat he is taking him to a nearby town for CT scan - hope it's not cancer.

Poor Tommy, I hate seeing him suffer.

We can go to visit on Saturday (they don't open for visitors on Fridays).
@milimelo, how did the x-rays look? When you say they are "keeping him", are they putting him on an IV or something?

Sending lots of vibes for Tommy... 
 
 
  • Thread Starter Thread Starter
  • #14

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
 
@milimelo, how did the x-rays look? When you say they are "keeping him", are they putting him on an IV or something?

Sending lots of vibes for Tommy... 
 
The x-ray showed clearly visible poop in the end of the colon  - so he is on his way to poop; but the stomach side had a 1 cm wide by perhaps 1,5 cm long darker area the vet suspects is the inflamed pancreas and problematic. Unfortunately they don't have trained ultrasound techs who could read the ultrasound and pinpoint the problem thus CT later in the weekend. 

He is put on the full blown pancreatitis treatment - pain meds, antiemetic, antacids, different, stronger antibiotic and he'll force feed as well. We'll bring Tommy's canned foods tomorrow when we go see him.

Thank you for the vibes, I think we need them all!
 
  • Thread Starter Thread Starter
  • #15

milimelo

TCS Member
Thread starter
Kitten
Joined
May 20, 2014
Messages
8
Purraise
1
Tommy has gone under the Rainbow bridge this morning at 510 am Amman time. The vet was him the whole night until he passed away. We are devastated but hope the little guy didn't suffer.

Looking into cremation.
 

quiet

TCS Member
Alpha Cat
Joined
Apr 7, 2014
Messages
432
Purraise
99
I am so very sorry. He knows you loved him.
 

nicolefrank117

TCS Member
Adult Cat
Joined
May 20, 2014
Messages
145
Purraise
3
I am so sorry for your loss. Just know that you did everything that you could for your baby and he is no longer suffering. 
 
Status
Not open for further replies.
Top