Cat with chronic pancreatitis

I have three cats. My oldest cat Charlie is 16 and recently diagnosed with chronic pancreatitis. I'm not sure if he has IBD as well. His other blood work is all normal which is quite amazing for a cat his age. His thyroid tests were normal as well. I'm trying a new food ( Blue wilderness turkey) after trying the vet prescribed Hills Z/d which he hated. I've been reading a lot and what comes out the most is high protein , fairly low fat and almost no carb foods are what's best. I've toyed with the idea of raw but the holistic vet didn't think that switching him to raw at his age would be a good idea. Especially with the compromised immune system and the issue of bacteria that could arise in raw food. he's getting a prebiotic/probiotic and digestive enzyme paste ( pro gut plus) and also a 1/4 Pepcid AC twice a day. He also gets a Chinese medicine herb pill for his pancreas. I'd like to add vitamin E and an omega 3 supplement but not sure which ones to give or how much. Should I be giving him something else? He weighs just over 8 lbs.

My question is: are there natural foods that I can give to help support his immune system and digestive system other than pilling him. How do all of you give your supplements when you have several to give throughout the day ? I'd like to be able to give him the supplements he needs in the least stressful way. He hates being pilled and will not eat pill pockets

Would appreciate some help from those who have cats with pancreatitis.
Thanks,
Terri for Sir Charlie, Minnie and Sophie my fur babies

I know there are several people here with kitties that have chronic pancreatitis.  It's very much a trial and error thing as to what works for each kitty.  I agree about the raw food.  I don't want to start a debate about that but like everything else with these chronic illnesses it is what works for a kitty.  The same is true of food, it's what works.  Do you give sub-q fluids?  I know for many kitties with chronic pancreatitis that really helps.  Is he on anything for nausea?  If nausea is an issue he can be on cerenia long term.  When it's given long term it's usually 5 days on and two days off.

Denice, I don't give sub q fluids. The vet didn't think it was necessary since he's eating well and isn't dehydrated. He eats wet food exclusively. I used to free feed dry food but don't do that anymore. Not even as a treat. I know this is going to be a lot of trial and error but I feel I need to do this. We love him so much and other than the pancreatitis he is doing well. Even the vet couldn't believe he was 16! He's on a 1/4 Pepcid twice a day. It's really hard to pill him tho.
Terri

Pepcid does have a bitter taste.  When my kitty was on Flagyl for an IBD flare the vet cut up the pills and put them in empty gel caps.  I am not sure what size they were but I know the lower the number the smaller the cap.  You can get them on Amazon and someone here not too long ago got them at The Vitamin Shoppe.

Denice, I'll try to find the gel caps. He's such a sweet cat, I'll try anything that'll make pilling him easier.

Hi Terri. My Sebastian (almost 13 years old) has chronic pancreatitis and we've been managing it for over a year now. Like Denice said, what works depends on the kitty and also the severity of the pancreatitis. Sebastian's is pretty "active" and so we've had to be aggressive with treatment and preventing flare-ups.

He's on a steroid (prednisolone) to keep the inflammation down and under control, an anti-emetic (Cerenia) to curb nausea and vomiting, an antacid (Pepcid) just like your Charlie, probiotics (including saccharomyces boulardii), Chinese meds, fish oil for omega-3s, B12 injections, RO purified water, and sub-q fluids. For Sebastian, the fluids are really important. We'll add pain medication (buprenorphine), an antibiotic (metronidazole), and/or an appetite stimulant (mirtazapine) only when needed. I put everything into empty gel caps so that he can't taste or smell the meds. It's the bitter taste that stresses him out more than anything; not so much the actual pilling. Every cat is different.

Keeping his stress levels low is also important. Stress can really affect him physically.

I agree with you about the diet in that it should be easily digestible, high protein, and low carb. I think the fat content could fluctuate, but shouldn't be high fat all the time. My TCVM vet advised me not to feed high fat during an active flare. We tried raw and it didn't work out for Sebastian. He gets a quality canned and supplemented home-cooked diet at about 70/30, respectively, which is scheduled into a special protein rotation.

GoHolistic- thanks for your reply. I'm sorry to hear about Sebastian. It's so hard for me to see Charlie go through this so I know how you must feel when your kitty has a flare up. I'm thinking maybe Charlie need some Cerenia since he's still vomiting once a day. He's got a good appetite and manages to keep his food down. When he vomits it's mostly bile and it's usually early morning. Tonight I emptied one of my small selenium gel caps and put his Pepcid in it. It went down a lot easier. You mentioned you feed a homemade diet- what protein do you usually give? What canned food is he on? I purchased some Hilary's blend and would like to make my own homemade food. I forgot to mention that I also have buprenorphine for pain.

Yeh, it is so disheartening when they're having a flare. I find myself saying, "Oh, no. Not again."     I will say, though, that the majority of Sebastian's flares have had a "trigger" and it can be difficult to nail down what those might be and I'm sure they are different for every cat.

What's Charlie's feeding schedule like? Is he vomiting in the early morning prior to breakfast? If so, this may be because of excess stomach acid due to an empty stomach (despite getting the Pepcid). You could try feeding him a small meal just before bed or offer him some 100% meat freeze-dried treats just before bed or very early in the morning if you have a chance to give them before he vomits (maybe keep the treats next to your bed).

I coat Sebastian's gel caps in Nutiva organic coconut oil. Makes them go down even easier. You could also use a little butter.

The Cerenia really helps Sebastian. It addresses a symptom and makes him more comfortable. But it is also important to get the inflammation down as it can cause scar tissue and permanently damage the pancreas over time.

Sebastian's protein rotation is here: http://www.thecatsite.com/t/274500/best-rotation-to-prevent-food-allergies/60#post_3572252. The only thing that has changed since posting his "menu" is that I no longer give him Nature's Variety Pork Formula during the pork rotation. It makes him itchy. He is also allergic to guar gum, so our options on canned foods are very limited. I use a product called Balance It to supplement the cooked meat. It is specifically designed for homemade cooked diets. If you're interested in making a home-cooked diet, please visit the home-cooked resources thread and consider starting a new thread in the Raw & Home-Cooked Cat Food forum.

He normally vomits early morning. Like really early... Around 4 am. I do give them all a large enough portion of canned food before bed so that they have enough to last them through the night. As I mentioned in a previous post I've now started putting his Pepcid in a gelcap rather than crushing it in a bit of water and syringing him. The gelcap seems to be working better and he hasn't vomited since Friday night. I'm also going to stop his Chinese meds which I just started recently. He's been "off" since starting them and I'm wondering if its the Chinese meds that are causing it. I'll keep him off for a few days and see how that goes.
I'm off to the vet this morning to get some more buprenorphine and maybe something to help with his appetite. He does eat but he's not eating enough. Maybe a half a can of blue wilderness turkey a day. I'm going to add some vitamin e (dry e ) to his food too.
Hope he doesn't have another flare up!

Glad to hear he hasn't vomited since Friday night. I wonder if the intact pill vs. crushed pill made the difference?    Yeah, Chinese meds can go either way. They can be pretty potent. You can ask about an anti-emetic / anti-nausea such as Cerenia and/or an appetite stimulant such as mirtazapine or cyproheptadine.

Also, I'm not sure if you're working with a vet on the vitamin E dosage. It is probably the least toxic of the fat-soluble vitamins, but you still don't want to give too much.

Went to the vet and got the mirtazapine. ? So far he's eating. Yay!
I'm going to cut his Pepcid to 1/8 tablet twice daily instead of 1/4 twice daily. He seems a bit out of it when I give him 1/4. Hopefully it'll be enough so that he doesn't start vomiting again.

Glad the appetite stimulant is working! I'm not sure if you've ever given it before. It makes some cats a little nutty and vocal.

Honestly, I've never heard of Pepcid making a cat "out of it" and would wonder if it is something else causing this.

I've never given him the stimulant before, yesterday was the first time. He did eat almost a full can of Blue Wilderness turkey throughout the day which is good. I gave him a 1/8 Pepcid this morning and so far he seems ok. He ate a bit but I think that's because I tried to get him to eat the Hill's z/d that the vet prescribed. He hates it although he ate a bit I think because of the stimulant. He's had runny light coloured stools the last two days so something is going on. I'll keep an eye on him today and hopefully they'll firm up with the probiotic I'm adding to his food. I swear this is so frustrating. Every night I go to bed crying because I think he can't go on like this and he looks so pathetic at night and then every morning when I wake up he's full of energy and wants to go outside for our morning walk- yes, he follows me and we go for a walk around the front and back yard. He looks like a young kitten when we're out there. Then as the day goes on he get progressively worse. He looks uncomfortable and like he's in pain I don't know what to do anymore. I can't keep giving him buprenorphine every day for the rest of his life can I? his bloods are normal except for the pancreatitis and I suspect IBD because of the acidic tummy. If I could just find the right formula for him regarding food and meds and get him stable and pain free. I suspect a chicken allergy but I'm not sure. If I could know for sure that it's not that I would make his food myself and add the necessary powdered formula with all the vitamins, taurine etc. But I'm worried that changing his diet again will cause problems. As it was I had to switch his food a few times in the last few days because he wasn't eating. Maybe that's what's caused the diarrhea. :smshfrk:

I know exactly how you feel when we see our babies like this.    But right when you've just about given up, they seem to get it together.

If you recently changed his food, then that could definitely change his stools. This happens to Sebastian, too. These kitties with GI issues seem to be particularly sensitive to changes.

So, correct me if I'm wrong, Charlie is on the following treatments:

• A probiotic/digestive enzyme paste
• Pepcid AC
• Vitamin E
• Mirtazapine
• Buprenorphine
• Canned food diet

You said you stopped the Chinese herbs. Do I have this all correct?

My guy is 19 and he is going through the same thing with pancreatitis, renal failure, IBD, and arthritis. I have tried so many thing with this cat and different foods including raw and nothing has stopped him from throwing up. He can throw up any time of the day with no warnings but usually I can see it in him because he is not acting normal. Sometimes he will go under my bed and stay there for hours which means it is pretty bad and he will usually be up on his haunches. He may or may not have stomach noises and sometimes there are no signs he is going to throw up. He has thrown up on his beds which means he was sleeping then throwing up. I also hear him licking the roof of his mouth like he is forcing himself to throw up. Most of the time it is a huge amount of water and some cat food it different stages of digestion.

Because Scratchy has IBD he can eat a lot of food and on a bad day may eat 1 - 2 cans of 85 gram wet food and on a good day he can eat upwards of 6. To address this I feed Scratchy a fork full at a time when I am home and I use an automatic feeder when I am at work. When I am at work or sleeping I give him a plate with 1/2 a can of food and then I put 1/2 can of food in each side of his feeder and set one for 3 hours and the other for 6. You want to feed your cat small amounts of food throughout the day so they digest it easier. By using feeders you can also ensure they are eating at good intervals so they will never be hungry. To help with acid build up I give Scratchy 0.45cc of Famotidine through a syringe in his mouth.

Dehydration is a big problem with cats with these issues and when they throw up the lose a lot of water The easiest way to check is the skin trick but it doesn't always work on old cats as the skin loses its elasticity. You can put one of your finger tips in the cheek pocket and it should be moist just like your mouth, if it is dry there is a problem. Hydration is very important and even if they are not throwing up moist stool can also dehydrate them. If they are dehydrated they will not feel well and have a problem digesting food and constipation. Scratchy is currently getting 150ml of ringers lactate every day to keep him properly hydrated.

Old cats have issues with B12 levels dropping so make sure to get your cat tested for this. Scratchy gets 0.25cc of B12 in his sub-q every week as his levels are not staying up without injections.

Scratchy also has arthritis so he gets 0.25cc of Buprenophine twice a day and he has been getting this for about 2 years now. He started off at 0.20cc twice a day and by the time his next dose was to be given I could see he was stiffening up. My vet said it was okay to give it to him when he was feeling really poorly to lessen the discomfort. I haven't seen any issues with him that have been caused by the drug other than maybe being a bit more relaxed. He is a 19 year old cat so he does not play and spends a lot of time either sleeping, eating, going to the bathroom, or staring out a window so it is hard to say if the drug plays a big part in this.

Scratchy also gets 0.15cc of Cerenia every other day and I inject this into his sub-q when it is needed. I don't know that this really does much, on average over the last year he probably throws up every 2 - 3 days. Usually within about 30 - 60 minutes he feels better after throwing up and can be back at the plate eating full time again. Other times it is a slow start with a lot of food licking until he actually starts to eat all of the food and not just lick the gravy off. I give him 2mg of Budesonide each day which is like pred but slightly different, if pred doesn't work then they may try this to see if it helps. Budesonide/pred does work in some ways for Scratchy because it helps keep his weight up. Scratchy is pretty anemic and when he was a few years younger he was 11lbs and now he is 7lbs. Without the Budesonide/pred he was just under 6lbs but even at 7lbs he is pretty much skin and bones with minimal muscle. He is able to jump on tables, chairs, and beds so he is not too bad and he can still do stairs.

Scratchy also gets 0.10cc of Cartrophen every two weeks to help with the inflammation in his joints. He is having problems reaching around to his tail and back legs now so there is more dead hair there which I try to brush out. He is so frail and has so many sharp corners now that I can't use a comb on him anymore and have to use a really soft brush.

Otherwise he gets a pre/probiotic and I am trying to get him to eat something the specialist gave me to help predigest the food which should make it easier for him to digest.

For the most part that is what Scratchy gets to help control his IBD and related issues. He just went 7 days without throwing up which he hasn't done since earlier this year. When he threw up the other day it was just a little amount of liquid and some grass so I was happy there was not a huge amount of water with it as usual. I am lucky with Scratchy and when he throws up I can change the food right away and it doesn't seem to both him. Sometimes his stools start to get really moist but are still formed to some degree but it doesn't seem to be related to him throwing up because he will do it with loose or firm stools.

From what I have read so far you are trying the same things I have gone through to find a happy ground and it can be hard. It is a huge issue and so many things such as B12 and hydration can impact it so you really have to go through everything and see what is lacking. My guys numbers are also really good for the most part but B12 is a different panel and they may not always test for this.

Go Holistic,
Yes that's right except for the Vit E I haven't given him that yet. I just ordered Dry E from Vitacost and should get it in a few days. Also, the new vet I went to ( actually and old vet but they moved further away so I stopped going there) which I just love and trust, gave me some Metoclopramide for nausea so he's on that now as well. So he gets:


A probiotic/digestive enzyme paste
Pepcid AC
Mirtazapine for appetite
Metoclopramide for nausea
Buprenorphine
Canned food diet

I'd like to start him of an omega as well but the last time I gave him canned food with fish he threw up. Just coincidence?
Terri

That guy thanks for your response. You're doing amazing things for you little guy. Honestly I find it mentally exhausting keeping up with the meds and constant worry about whether or not it's going to be a good day or a bad day. I'll continue to do whatever it takes for my Charlie but I'm wiped. I'm a worrier to begin with so this just adds to my stress level. But I love him as I love my other two babies and will do whatever I have to do.
Scratchy seems to have a good appetite. My Charlie barely eats an 85 g can of wet a day! I feed him many times throughout the day which is easy since I am at home all day. He never refuses food but he seems to lick at it and nothing much goes in each time. My other two cats can polish off a can in minutes! Hopefully this new anti nausea med will work and he'll feel better and eat more. It can't be too much fun eating when you're feeling sick to your stomach. He's just gone 5 days without throwing up so that's a start. The vet gave him a B12 shot yesterday and I'm to give him one shot of .04 every week for 6 weeks. She also gave him fluids on my request. That seemed to help him a lot yesterday but this morning he's quiet again and seemed off. I gave him .02 of buprenorphine because I didn't give him his dose last night as he seemed to be doing so well. He even played with his toys which he hasn't done in weeks!

How's Charlie doing?

To address your question above, a good quality omega-3 supplement from fish oil is different from feeding actual fish. If you do decide to try an omega- 3 fish oil, I suggest introducing slowly. Pancreatitis kitties seem to be so sensitive to change.

Charlie is doing better thanks. If I stick to a schedule and make sure he gets his meds on time then he's ok. He just looks so pitiful after I pill him. I know he knows I'm doing it to help him but he really doesn't like it. At the moment he's on and antiemetic and the Pepcid twice a day. I was able to purchase B12 at the pharmacy and am giving him .4 ml once a week by injection with the Vet's blessing. I've given him an appetitive stimulant twice, 3 days apart and that seems to have boosted his appetite. As long as he's not nauseous he eats pretty well but still not much more than a half a can of wet. I've also switched the other cats to eating his food because it's just too much hassle to try to keep the bowls separate and the other day he got into their beef canned food and he threw up. So it's turkey and venison for the whole gang!
I also gave him a couple of drops of a very good quality human grade omega 3 supplement but he seemed a bit off the rest of the day. I'm going to start again with one or two drops per day and see how that goes. I'm wondering if he's allergic to fish?? I know that when I had the brilliant idea to give him a bit of fresh sardine, he ate it with gusto and then threw the whole thing up.

Glad to hear he's doing better! A good quality fish oil typically does not contain the protein which causes allergies. I think you're smart to introduce it slowly, even one drop to start. It took me FOREVER to introduce fish oil into Sebastian's diet. If you feel Charlie just can't tolerate it, then you may decide there's no sense in pushing it. It's whatever works best for your cat.