Chronic pancreatitis

Hi everyone,

I'm hoping someone can give me advice on what to do. My cat is 15 years old and for the past year or so has only had diarrhea. He has lost a lot of weight and is very thin. He now poops outside of the litter box onto the carpet. He also drops diarrhea all around the house because his poop is just liquid. We took him to the vet and $2000 later, the vets suspect chronic pancreatitis. We have tried different medications and foods and nothing has changed. We can only try to manage his condition but so far no luck. Although he has lost weight and has diarrhea, he doesn't act sick at all. He is still active, very social and seems to always want to eat. This has made it tough to consider the idea of putting him to sleep. It must be painful for him to have diarrhea but he seems to be doing fine otherwise. It has been very difficult to take care of him since he is ruining the house and after spending money we don't have on a vet for medications and food that doesn't work, we are running out of ideas. We have even told by the vet that he will be that way forever and can't be cured. Based on his behaviour is it inhumane to put him down or does it seem like it is time? Does anyone have any advice? The best scenario for us would be to find an easier way to manage him because after all we've done nothing has changed. Thanks everyone for your help!

spot101 said:

Hi everyone,

I'm hoping someone can give me advice on what to do. My cat is 15 years old and for the past year or so has only had diarrhea. He has lost a lot of weight and is very thin. He now poops outside of the litter box onto the carpet. He also drops diarrhea all around the house because his poop is just liquid. We took him to the vet and $2000 later, the vets suspect chronic pancreatitis. We have tried different medications and foods and nothing has changed. We can only try to manage his condition but so far no luck.

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Did the vet do a fPLI test? That is the test for pancreatitis.

Here's some info on treating chronic pancreatitis. The link to the original post doesn't work anymore so I copied and pasted from a copy that I had saved. Part of the post is about diabetic cats which I removed since it doesn't seem to apply to your cat:

(originally posted at http://www.felinediabetes.com/phorum5/read.php?8,876722,876722)

****CHRONIC PANCREATITIS****
(or does my cat have a pepcid deficiency?)


the best diagnostic test available is the fPLI (feline pancreatic lipase immunoreactivity ) http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml not perfect but far better than the options we had in the recent past.
it is far better to have a diagnosis (always) because then you and your vet can form a plan better than just pepcid. SQ fluids and pain management top the list. CP flare ups ARE painful...look carefully at how your cat is acting, it is not easy to tell when a cat is in pain, they hide it well. it is not just nausea that is keeping fluffy hunkered down under the chair, it is pain.
possible tools your vet might have you use:
~SQ fluids
~ pain meds
~ anti-nausea meds (hey look pepcid falls in this category)
~appitite stimulant (new med called mirtazapine (remeron) works well for cats)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed

can all be used to help the cat through the flare up. your vet can work up a treatment plan for managing your cat's CP flare up attacks.

the veterinary community is still undecided on the issue of fat content of food and whether or not it is something to be considered in feline CP. it is very much an issue in human or canine CP, however felines are very unique in how they utilize the fats (and protein) in their diets. anecdotally, some owners find that lowering the fat content (to about 35% or less) of their CP diabetic cat's diet even though it means they have to raise the carbs helps. ECID, you would have to experiment on that yourself. just a reminder on the topic of food..as a CP flare up begins cats will eat less in the days leading up to it and often not eat at all when the attack is in full force, know that it does not take many days of reduced calorie intake to make hepatic lipadosis possibly rear its ugly head, especially in a liver already compromised.

cats that are simply diabetic with no other condition going on should not need pepcid ever...if you are reaching for the pepcid again, maybe reach for the phone and call your vet instead and discuss the possibility that your diabetic cat might be one in that 40%.

links for those that wish to read about CP further:

http://books.google.com/books?id=to...onepage&q=feline chronic pancreatitis&f=false

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6623&Category=1004&O=Generic

spot101 said:

Hi everyone,

I'm hoping someone can give me advice on what to do.

Click to expand...

In addition to asking the same question, (has your cat had the fPLi test?), and while pancreatitis can have many symptoms, to have consistent diarrhea without other symptoms for so long (and with weight loss) sounds a lot like severe IBD (Inflammatory bowel).  Was IBD discussed, and considered?  The first  thing I would suspect given these symptoms and the absence of vomiting and pain is IBD.  Even if a cat was positive for pancreatitis, that doesn't preclude also having IBD.  My cat had both pancreatitis and IBD so he had a very complex diagnostic situation but we were able to diagnose both separately. 

Typical pancreatitis has vomiting attacks, is painful, causes a cat to not want to eat, has flare ups that get worse and then better, and in general the cat appears to be in distress during attacks.  Pancreatitis is so serious that it can be fatal.

Typical IBD has some combination of diarrhea and vomiting, with weight loss when it becomes severe.

Distinguishing between IBD and other illnesses is often done in the early stages by attempting to treat it and see if it responds.  In other words, if you treat the cat for IBD treatments and the cat gets better, then its a good bet that the cat has IBD.  Standard first line attempts at this include diet change, Tylosin (an antibiotic that can improve the gut's bacteria balance), probiotics, B12 injections, and if none of this helps then trying a course of prednisilone.  Within 2 weeks of starting prednisilone, there will generally be weight gain and stool improvement if the underlying cause was IBD  (and if the disease is responding).  Surgical biopsy is another option.

Were any of the treatments above tried before your vet came to the pancreatitis conclusion and was the fPLi test run?

For what it's worth, here are my thoughts on IBD, which, as StephenQ says is highly likely: http://www.thecatsite.com/t/278273/the-well-known-problem-of-ibd-or-lymphoma/90#post_3576295

Have B12 levels been tested? If they are low, diarrhea will not resolve until it is normal.

Was kitty checked for EPI? Losing weight is not just necessarily malabsorption from IBD, but can be due to EPI. http://veterinarynews.dvm360.com/ex...ficiency-cats-more-common-veterinarians-think

As to the diarrhea... have you run the fecal PCR tests, looking for T foetus, coccidia, clostridium, etc?

Re: pancreatitis and EPI. Both can be difficult to diagnose via tests and imaging. Sometimes you have to treat for it, and see the result.

As re: EPI you may want to talk to the vet about pancreatic enzymes (not digestive enzymes, not the same thing). I know many kitties responding to pancreatic enzymes that did not appear to have EPI based on the test - yet clearly they needed the enzymes.

For pancreatitis, the standard treatment is cerenia to prevent nausea, and it has been found to be anti-inflammatory. An appetite stimulant is often used if kitty isn't eating. Fluids can be administered to help kitty kitty flushed and hydrated. The main issue is introducing as few toxins as possible into the body. Here is a thread by someone with a cat with pancreatitis and IBD that responded to a change in diet and probiotics: http://www.thecatsite.com/t/246201/raw-diet-questions-and-concerns

And here is a much more complicated case: http://www.thecatsite.com/t/264363/sebastian-is-back-at-the-vet-suspected-pancreatitis-again


Whether "IBD" or "pancreatitis" or a protozoa, I'd put kitty on Beech Nut baby food for a week to eliminate all "other ingredients," and give kitty's system a rest - and follow the emergency stop diarrhea instructions, here: http://www.ibdkitties.net/Probiotics.html

See what happens and go from there.

spot101 said:

Hi everyone,

I'm hoping someone can give me advice on what to do. My cat is 15 years old and for the past year or so has only had diarrhea. He has lost a lot of weight and is very thin. He now poops outside of the litter box onto the carpet. He also drops diarrhea all around the house because his poop is just liquid. We took him to the vet and $2000 later, the vets suspect chronic pancreatitis. We have tried different medications and foods and nothing has changed. We can only try to manage his condition but so far no luck. Although he has lost weight and has diarrhea, he doesn't act sick at all. He is still active, very social and seems to always want to eat. This has made it tough to consider the idea of putting him to sleep. It must be painful for him to have diarrhea but he seems to be doing fine otherwise. It has been very difficult to take care of him since he is ruining the house and after spending money we don't have on a vet for medications and food that doesn't work, we are running out of ideas. We have even told by the vet that he will be that way forever and can't be cured. Based on his behaviour is it inhumane to put him down or does it seem like it is time? Does anyone have any advice? The best scenario for us would be to find an easier way to manage him because after all we've done nothing has changed. Thanks everyone for your help!

Click to expand...

Spot101 I see the original post is from 2015 but I am in this EXACT situation today. 15 year old, a year of diarrhea, pooping everywhere, very skinny....Can you tell me what happened to your cat? I would do anything for her just to feel better but nothing is working. I just can't keep hauling her to the vet (although I would), she hates it so much I think it adds to her stress. So do you still have your cat or...not. Any insight to our future would be so helpful.

Hi FelineGroovy .. I doubt you'll get a response now. How about starting a thread about your girl? Others may have some experiences to share.