Obi has an appt. with internal medicine today - He has Pancreatitis

My only addition is that with the 'over-grooming' on the abdomen, I would look more towards possible skin irritations, as my uneducated (in terms of formal vet training) but long time cat person, is that if there isn't anything other than the hairballs in terms of 'vomiting' you might be more at a skin issue rather than internal.  It might even have been a past issue that has resolved itself, but Obi is now in the habit of excessively grooming that area and is finding it hard to break.

It is never an easy decision, but as I say in the absence of other symptoms I would adopt a watch and see approach and save the stressful procedures when their are many pointers and definitive results from them.

Maybe talk to your vet and get a specific definition from him or her on what they would consider the difference between vomiting, regurgitation, and expelling hairballs.  Like many things we might use the terms interchangeably, but they do have specific medical definitions.  That might help you decide if there is really a sign of lymphoma or not, because if what is happening doesn't truly qualify as vomiting then it might not even be a consideration.

I wish you the best.

You may just have to give it at another time of day is what I meant, but didn't say very well. 

However, all things considered, the slippery elm hasn't "fixed" your problem.  I'd give the new meds a try without slippery elm if that's what it has to be.  If there is a way to administer slippery elm at night after all other meds have been absorbed, great.  But if *I* had to choose between them, I'd try the new meds.

Thank you, Enypaf.  There is a school of thought in vet medicine now, especially with the feline specialists, that hairballs are not "normal".  this irritates me, as every cat I have ever had threw hairballs.  In any case, Obi has been known to throw hairballs every day, and that is not good.  Please read my post titled, "Obi has a diagnosis of pancreatitis".  There is a summary there of my today's visit with an internal medicine doctor.  Obi has chronic pancreatitis.  All his other organs are in great shape.  We dont know if he has IBD or lymphoma, or some other GI issue.  And, as I understand it, it is very difficult and expensive to get a definitive diagnosis.  And the treatment is pretty much the same.  The overgrooming was not really addressed today.  his belly is over groomed, but she looked at his skin and felt it looked very healthy and normal.  Go figure. 

I think if everything is working right at all times then there would be no hairballs.  I think our kitties, like us, have those times when things in the digestive system don't work perfectly.  The result for kitties is the occasional hairball especially during shedding season.  I think there now seems to be two extremes.  One extreme is that there never be a hairball the other extreme being that it's just cats being cats no matter how many hairballs there are.  I think reality is that an occasional hairball is going to happen but it shouldn't be something that is seen a lot.  If there are a lot of issues with hairballs then something isn't right either with the kitty's digestive system or their diet or grooming.

myrnafaye said:

 
Thank you, Enypaf.  There is a school of thought in vet medicine now, especially with the feline specialists, that hairballs are not "normal".  this irritates me, as every cat I have ever had threw hairballs.  In any case, Obi has been known to throw hairballs every day, and that is not good.  Please read my post titled, "Obi has a diagnosis of pancreatitis".  There is a summary there of my today's visit with an internal medicine doctor.  Obi has chronic pancreatitis.  All his other organs are in great shape.  We dont know if he has IBD or lymphoma, or some other GI issue.  And, as I understand it, it is very difficult and expensive to get a definitive diagnosis.  And the treatment is pretty much the same.  The overgrooming was not really addressed today.  his belly is over groomed, but she looked at his skin and felt it looked very healthy and normal.  Go figure. 

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The overgrooming of the belly is most likely due to the pain caused by pancreatitis.

That's a frustration too; I recognize that is a possibility, but he does not appear to have any abdominal sensitivity at all.  The vet palpated him really well, and I have too, and he just likes the attention.  However I realize there is an inflammatory process going on which at t he least causes discomfort.

Thats what I have decided to do, Peaches.

I am also worried that he is now hiding under the bed.

I'm sorry about the diagnosis, @myrnafaye. What was the pancreatitis test called? The two most widely use are the SNAP fPL (done in-house with results in minutes) and the SPEC fPL (sent out to TAMU and is more reliable), both provided by Idexx Labs.

I'm not sure how much you remember about my posts in some of your other threads. Sebastian has chronic pancreatitis, and it started out as him tossing frequent hairball "tubes." That was followed by a fussiness with food before he had a full-blown attack and was hospitalized. We tried SEB, but it was not potent enough to help with his pancreatitis, and it was burdensome to get in him. I also didn't want it interfering with his other treatments. We also tried EYL, but that didn't help either. I have Sebastian on more of an "anti-inflammatory" regime, since what ultimately fixed the hairball problem was getting the inflammation under control. He does get probiotics and well as a myriad of other things.

What is the purpose of starting Obi back up on Reglan? Will they continue the prednisolone? Since pancreatitis is painful, the buprenorphine will help with that. Pancreatitis is inflammation of the pancreas. This inflammation is a bugger and can be permanently damaging.

Here's a good document from Idexx that explains how feline pancreatitis is treated: http://www.idexx.es/pdf/es_es/small...pec-fpl-treatment-for-feline-pancreatitis.pdf

If Obi is hiding under the bed and this is a new, abnormal behavior for him, then he's likely not feeling well and may be in pain. 

Hi, Go, Of course I recall your Sebastian posts and was reading them this morning.  I have stopped all the supplements for now.  I read on line how SEB can interfere with absorbtion, and so perhaps that is w hat  happened, as he was at a higher dose of pred, then we dropped him to 2.5, then I started the supplements including the SEB.  Those are off the table for now.  Over and out.

The reglan is for the vomiting and nausea, if that is happening.  He is certainly continuing to vomit hair.

The pancreatic function was checked in house, the SNAP.  I figured the more detailed test would just give more information but would not necessarily effect the course of treatment.  I just spoke with the vet and she agreed that B12 was worth a try.  Yes, Obi is on 2.5 mg prednisolone, and if he does not improve by Friday, we will increase t hat.

I know its a bugger and can be permanently damaging.  Yes, I read, including the article you cited here.  I found that right away and saved it the IDEX article.

Obi was under the bed this morning, but he has emerged.  His appetite is not as good as I would like but expecting miracles in 24 hours in a 15 year old cat is probably not realistic.  How old is Sebastian?  And, can you let me know w hat you are doing about Sebastian's anti hairball routine.

Are you concerned about whether or not Sebastian has IBD or lymphoma?  

Here's a kicker:  Obi was at the vets for 4 hours yesterday, as was I.  in the middle of the night I was very sick, must have been something I ate, and I did not eat much yesterday.  I vomited and was quite sick, felt awful.  Obi, despite his own problems, showed up and laid down next to me and put his paw on my mouth.  Arent they amazing.

We did not start Sebastian on pred right away. It was two months after his first attack last year that we started pred since he kept flaring up. After a month of doing well, we tried to reduce it. He flared again. In some situations, it might take some more time (months?) for the inflammation to go down and the system to normalize. We decided not to continue to try to reduce Sebastian's pred since he kept flaring. Mind you, his flares were pretty severe. Violent, continuous vomiting (to the point where he develops hypokalemia), anorexia, and pain. He had lost four pounds in one year. We felt the potential damage that could be caused from the inflammation and disease itself was more critical than the side effects of the pred. While the pred was doing it's thing, I focused on healing his gut. It took over six months to get him on the regime he's on now. I had to introduce one thing and a time and very slowly. If he goes six months without a flare, we may try again to reduce the pred.     August will be six months.

Reglan was the go-to drug for a long time, but now a lot of vets are using Cerenia for nausea and vomiting. You may want to ask about that. Sebastian is still on it.

Sebastian is estimated to be 12 years old.

He is not on any specific hairball remedies. Getting the inflammation under control and getting his system working the way it should is what fixed the hairball issue. He will now only rarely (once every couple of months) throw up a hairball and he grooms A LOT (it's his happy activity). He passes the hair in his stool.

The idea of IBD and lymphoma has been discussed with the vets I worked with. We feel the regime he is on would be addressing IBD if that was a factor in all this, but there is a part of me that thinks the pancreas has a mind of it's own. It's a very ornery organ.    I decided not to dwell on the possibility of lymphoma. I promised Sebastian I would do my best, take care of him, and keep him pain-free. I would eventually know based on his progress or decline whether it was something like cancer.

I also wanted to comment on your post in @arinlars thread here where you said, "First, I think one has to decide on a path - holistic or alopathic. It is hard to combine both." Sebastian is on a regime that addresses both his symptoms (allopathic) and whole body healing (holistic), and our recent addition is Traditional Chinese Medicine. Like I said above, it took awhile to get to this combination, but I do think an integrative approach can work. It's important that all the vets you're working with know what the other is doing. While the primary vet might not be too keen on the idea of other vets getting involved (as was the case with mine), we still maintained a relationship that was open, honest, and collaborative. In the end, our primary vet was a least grateful that I kept her in the loop and asked her opinions, even if we didn't always see eye-to-eye. I continue to send our primary vet any notes/suggestions I receive from the holistic vets and vice versa.

I'm sorry you were sick.     It's such a terrible feeling when we don't feel well, but we still have to try to take care of our furbabies who also don't feel well. 

Hi, Go.  Thanks so much for all the information and support.  You use cerenia instead of metacloprmide?  Is it expensive?

I totally agree with you about the pred, especially in small doses.  Obi is at 2.5 and if he does not do well this week, we will be discussing raising it.  BUT it sound like an alternative might be cerenia, is that for vomiting or diarrhea?  Obi only vomits, and mostly almost exclusively hair balls.

Yes, this kind of came on slowly; in late Feb he was throwing hair almost daily.  So we put Obi on pred and metaclopramide and pepcid.  Then he did better, as I recall so we got rid of the metaclopramide and reduced the pred, but at that time I think I also started the SLB, which may have decreased the effectiveness of the pred.  Poor Obi! I feel guilty, but I did not know.  So for now, he is just getting his meds and food, and I am hoping that we can restore his health.

H e was prescribed some pain medication but I think it alters his personality so I may lower it.  I dont think he is in pain.  He was palpated very thoroughly at the vets, and he did not object at all.

I would also rather not think about lymphoma,  I jus t  want to keep him eating, drinking, and not vomiting hairballs. 

Yes, our vet is primarily using Cerenia for cases of nausea-associated vomiting, so that is what Sebastian is on for nausea and vomiting caused by his chronic pancreatitis. It really helps him. It shouldn't be given more than five days in a row, so he's on it Monday through Friday and takes a break from it on the weekends. Sebastian's situation is a bit extreme, though. I don't think many kitties need to be on Cerenia long-term, but we felt it was something we needed to provide to keep him feeling good. Reglan is a prokinetic that is used when there is the possibility of a motility issue. I've become so numb to what's expensive nowadays that I really can't answer that question. I'm sure the cost varies by area and by vet, so you'd have to ask your vet. Cerenia is not an alternative to pred. And as far as I know it does not help with bowel movements...just nausea and vomiting.

Don't be hard on yourself. Cats are masters at hiding their ailments and confusing their humans. I, too, didn't know that his hairballs and fussiness with food were signs of something bigger. I'm making up for it now by going above and beyond to help him.

Hi, Go:

I asked at my clinic about the diff between metaclopramide and cerenia.  I was told t hat metaclopramide is an anti-vomiting drug that increases the motility of the digestive tract.  And also this is what it says in my discharge summary.  They said cerenia is for nausea... I guess that is what you are saying as well.  I know cerenia is not a substitute for pred.  I s sebastian on B12 injections, how much, and how often?  I asked for these yesterday and noticed a pretty immediate improvement in Obi's demeanor - he is not all better by any means but I would say he is much better than he was yesterday.  

I just wanted to say that Obi seems to be coming along nicely.  Tonight he was RUDE - he jumped on the dinner table to nose in on our pizza.  So, he must be feeling better, right?

My only complaint is that his anti parasitic and pain med need to be syringed, and he HATES that.  Fortunately, the anti parasitic rx is only for another 2 days, and I think the pain med is superfluous at this point, but I wont stop giving it till the internal med vet is in on Friday and I can ask.

I do want to know more about vitamin B12 and its role in IBD and other digestive issues; can anyone assist?

Sorry @myrnafaye! I read your question about B12 and then forgot to respond. I do this ALL the time, with email and text messages, too. I'm way too young to be so forgetful. 

Sebastian is on B12 injections. In fact, all three of my cats are now on B12 injections. I have gone around and around with my vets about the frequency and we can't seem to come to an agreement on this. It's my understanding that B12 injections are usually suggested by vets in a sort of tapering schedule, such as once a week for month, and then every other week, and then every two weeks, and then monthly, etc. etc. The suggested frequency varies by vet. The integrative vet we work with thinks they should be given more frequently, but our traditional vet thinks less frequent is plenty. I'm trying to meet somewhere in the middle that they both agree on.

Here's some good information on B12 (also called cobalamin):

http://www.ibdkitties.net/B12.html

http://www.felinenutrition.net/b12.html

http://vetmed.tamu.edu/gilab/research/cobalamin-information

The fact that Obi was rude is a great sign! 

Hi, Go.  Yes, Obi is on a tapering schedule of vitamin B as well. I will be discussing that with the internal medicine MD when she is available.  I dont know why they do this - do you?  if IBD kitties are often vitamin B deficient and that impacts motility and absorbtion.

Yes, his not having manners - again- is a great sign.  As is his  healthy appetite.  He has not thrown up since last week - but he is on reglan 3 x's a day, 1.5 mg's.  And, I saw a big haiball in his stool, not to bore you with shitty details...but I was happy to see that. 

Does vitamin B12 deficiency CAUSE IBD etc?  I get that cats with IBD, etc, often have low B12 but is it possible that it causes a disease process?

myrnafaye said:

 
Hi, Go.  Yes, Obi is on a tapering schedule of vitamin B as well. I will be discussing that with the internal medicine MD when she is available.  I dont know why they do this - do you?

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I don't have any references on hand, but I think they do this because they assume that in the early stages of the disease the deficiency is greater. As the B12 is incorporated, it can help heal and normalize the GI tract, which over time lessens the degree of the deficiency and thus the dose is made less frequent.

myrnafaye said:

 
Does vitamin B12 deficiency CAUSE IBD etc?  I get that cats with IBD, etc, often have low B12 but is it possible that it causes a disease process?

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It's my understanding that a B12 deficiency is usually the result of some condition, disease, or genetic disorder. If, for example, a B12 deficiency was a result of malnutrition or a genetic disorder, it is possible that it could cause GI problems. In the link I gave you above from TAMU, it states:

As all cells in the body require cobalamin for single carbon metabolism, it has been hypothesized that cobalamin deficiency may actually contribute to the clinical signs and manifestations of gastrointestinal disease in some patients.

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For me, this raises the question of whether cats who vomit hairballs - more than "once a year" - should be given an occasional B12 injection.

Obi may have improved as a result of the reglan - or, the off chance he had parasited, and the de-wormer did the trick - but he was already on pred, 2.5, and pepcid.  The only real changes were the B12, the addition of reglan, which he had been on before, and the de-wormer.  He is pretty much back to his old self as near as I can see.  He does not look like  a sick kitty at all.

Im very grateful.  Very happy.