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

Thanks, Denise,I am losing hope that I will ever be able to stop Obi's vomiting of hairballs.  And considering that he has a diagnosis of pancreatitis, it seems very important TO get the hairball vomiting to stop...

Anyone have experience with ranitidine in the treatment  any of the above?  what did you use it for?  was it effective?

I am not too familiar with this medicine to treat pancreatitis or IBD, although I have seen it mentioned for antacid therapy. Product descriptions say that it is used to primarily to treat stomach and intestinal ulcers, and that it is in the same class as Pepcid.

http://www.petplace.com/drug-library/ranitidine-hcl-zantac/page1.aspx

How do you know if your cat needs pain medication?  have you seen your cat literally have good days and not so good days?  Obi  had a great couple of days - last week, actually, he seemed to be improving..now today, he is eating well but  he is very quiet...I suspect there is a hairball in his tummy, but is this "normal" behavior for cats with pancreatiis?  do I call the clinic/ (I have called them several times over the weekend, and I hate to be a pest)...or, do I just leave him be and tell myself that as long as he is eating and not vomiting food, he is probably OK - more or less...?

myrnafaye said:

 
How do you know if your cat needs pain medication?  have you seen your cat literally have good days and not so good days?  Obi  had a great couple of days - last week, actually, he seemed to be improving..now today, he is eating well but  he is very quiet...I suspect there is a hairball in his tummy, but is this "normal" behavior for cats with pancreatiis?  do I call the clinic/ (I have called them several times over the weekend, and I hate to be a pest)...or, do I just leave him be and tell myself that as long as he is eating and not vomiting food, he is probably OK - more or less...?

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It is tricky to tell when, or even if, a cat is in pain. I gauge if Sebastian is in pain by whether or not he is sleeping in unusual places and his position. He will also go quiet. He has "sick spots" he goes to and only goes there when he doesn't feel well. He'll curl up in a ball real tight or tuck his legs and feet close to his belly when his tummy hurts. I know this because when he feels well, he likes to sprawl out and/or lay on his back with his belly in the air.  I do A LOT of observing (without hovering). Pancreatitis is very up and down, especially in the beginning.

Actually, Sebastian has been a little off the last couple of days. He's sitting in the meatloaf position more than usual and curling up in a cardboard box that I have sitting on the floor (he's not usually a box cat).

Has Obi had blood drawn for the GI panel yet?

Yes, it was shipped to Texas today.  I had them draw extra blood when I had him in for his consult with internal medicine, "just in case", which saved me another office visit and blood draw, not to mention stress.  As it has to go to Texas, it will be a few days before I get results.  Thank you for asking, and will post when I get t he results (and understand them).

myrnafaye said:

 
Yes, it was shipped to Texas today.  I had them draw extra blood when I had him in for his consult with internal medicine, "just in case", which saved me another office visit and blood draw, not to mention stress.  As it has to go to Texas, it will be a few days before I get results.  Thank you for asking, and will post when I get t he results (and understand them).

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Yeh, I think Sebastian's results took a full 7 business days. Good luck and sending vibes! 

SEVEN days!  Oh dear.  If I knew the name and phone # of the company, I would be calling and bugging them.

Wednesday update on Obi:

Waiting for the GI panel from Texas, hoping that sheds some (positive) light on the subject.

Obi has thrown a couple hairballs a few times within the last several days.  It seems to not effect him at all; he still wants his dinners, and has a very good appetite.  I remain puzzled, as his only real symptom at the moment is hairball vomiting.  NO food vomiting, no diarrhea.   Just hairballs.

Poor Obi. You'd think his throat hurts. 

Obi's blood work came back.  1.  HIs B12 was LOW. 2.  His pancreas shows some inflammation, but it is functioning within normal range.  The internal med doc thinks there is an inflammation in his ilium, and she believes it is lymphoma.  She also acknowleges that the regular internal med doc - who is on maternity leave - may have a different opinion.  She thinks Obi should have an ultrasound.  I dont think so.  I  dont think it will change the course of treatment that much, and will add more cost to my stress.  Mostly though, I am thinking it will not change the treatment.  WE are going to increase his pred, see how he does, and maybe add Chlorambusol.  She will add that if he does not respond to, probably 10 mg pred; I am not sure if I want to add that at 10 or at 5.

I am not sure how she is distinguishing in her speculations between lymphoma or IBD...I think she is aware of that IBD/lymphoma relationship, and I think she feels that Obi has crossed into lymphoma.  She does not think, if we ultrasound him, that is will show IBD, she thinks it wll probably show lymphoma.  I am not sure I want to know, especially as the treatment will not likely change.

Thoughts appreciated.

Wow...a lot speculation going on. I suppose she is speculating inflammation in the ileum because one of its main functions is to absorb Vitamin B12 and bile salts (source). But this is common in IBD, so I don't understand how or why she is so quick and confident to come to the conclusion of lymphoma, especially when imaging hasn't been done. Obi is not even displaying signs that go along with lymphoma (loss of appetite, weight loss, etc.). I'm also a little confused on the comment that the ultrasound would show lymphoma but not IBD. Unless it is a mass, lymphoma and IBD can look very similar, if not identical, on an ultrasound. 

Chlorambucil/Leukeran is a chemotherapy drug typically used for cancer. It is sometimes used in cases of severe IBD when they stop responding to pred. My personal opinion (I hope I don't get flagged for this) is that talks of incorporating a chemotherapy drug at such an early stage with no imaging, no biopsy, and no marked symptoms other than hairballs, seems a little overkill. I can't say I like the information you were given, and I'd probably take all the lab results and reports and get [another] second opinion.

 

P.S. Talk to the vet about B12 injections. This is usually the recommended course of action when B12 is low.

I agree.  Chemo is some bad mambo stuff...I better have a real diagnosis before throwing antineoplastics at my cat.

Hi, Go,

yes, first, Obi is on B12.  it was quite low.  236 when normal is 262-658.  So he is on injections and will continue to be.

She recommended an ultrasound.  I dont know how many times I have to say I am not having him ultrasounded.  If I  had all the money in the world, maybe I would but I dont, and it wont change his treatment.  The only thing that would change might be that if there was a definitive diagnosis of lymphoma, he might start sooner on chloramusol.  But right now he is on 2.5 mg of pred, and tht is way below what he should have for his weight, so we are bumping him up, and probably stopping the reglan.

I agree that it seemed a "fast" diagnosis, that was not exactly a diagnosis, but her feeling about what is going on.  I agree totally about getting another opinion, and that is in the works; I have asked another vet at the clinic to review Obi's recent labs and confer with me.  My bet is that he wont commit much because like you, he agrees that if Obi is eating, not vomiting, etc, those are all good signs.  The other vet says something is going on and it has progressed to more frequent hairballs.  NO, he is not displaying signs of lymphoma or even of what I have read here about IBD.

So yes, I am in process of getting another opinion, and I also need to find a regular vet.    

I know it's frustrating, and it's exhausting to get another opinion. It almost feels like starting over, but sometimes has to be done, even if it's going to a completely different clinic.

From what I gather from your posts, you've got one side of the spectrum saying he's fine and the other side saying he has lymphoma. How's that for difference of opinion!? I do think something might be going on with Obi since such frequent hairballs is not normal. I believe that even a mild version of pancreatitis could create some GI disruption. Now anything is possible, and he could be in the very early stages of lymphoma, but to me it doesn't quite add up to that just yet. But I am not a vet and only a vet can diagnose Obi.

I know you said you are not getting an ultrasound, but just be aware that each vet you talk to will probably suggest it because that would typically be the next step in the process. After an ultrasound, it's a biopsy. So if you do not want to go through with the typical next steps, going forward you'll be working with your vet(s) to treat Obi based on symptoms and assumptions only and maybe standard blood work. Please don't misinterpret this as me trying to talk you into getting an ultrasound. I just want you to understand that the vets can't definitively tell you what's going on inside if they don't have an opportunity to look inside.

Yes, Go, I get that.  I am not sure anyone is saying that Obi is FINE, with regular hairball heaving.  I think the vet who delivered the opinion thinks that he has an inflammatory process going on, and there is that connection between chronic hairballs, IBD and lymphoma; since he is 15, and the hairball throwing has increased, I think she feels that its a logical process toward lymphoma.

I was hoping to have another vet at that clinic review Obi's new lab work and give me an opinion but he says he cant do this without seeing Obi.  That frustrates me too; what is he going to see that the first doctor did not see?  she examined him, palpated him well, did not feel anything, Obi was not in pain or with a tender abdomen, so I beginto think Is this all about Money, although I know it is not.  So:  I either wait for the regular internal med doc to come back first or second week in July; or I find another vet, have his paperwork transferred, and have an altogether new opinion.  :  (     

Oh, okay. I misinterpreted.

That is frustrating!

It IS frustrating.  Obi has no clinical signs of disease except for the hairballs, and a low B12 (easy fix); and a slightly inflamed pancreas with a normal level of functioning.  I WOULD like another opinion but I may have to wait til the vet comes back from maternity leave - unless I cant wait.

You know, if I really thought it was cancer but the only symptom is hairballs with vomiting, I'd clean him out with hairball cat meds with petroleum products then start the Vet's Best Hairball relief again.  The one time you tried it, he may have been full of hairballs.  That's why I dosed my cats first, to give the Vet's Best a real chance.  I'd try that over chemo.

Thank you, Peaches, but there is clinical information that Obi has GI disease.  The pancreas does not get inflamed if GI disease is not present, it is just a question of what GI disease is present.  Clearly the lack of motility due to GI disease in inhibiting his intestine from pushing the hairballs through.