Please help! Cat with pancreatitis won't eat or drink

Well, he hasn't eaten on his own since he was at the vet! dunking him is a brilliant idea! I'm fairly certain stress caused this one (his first one.) we were out of town for quite some time, but had a care giver come over several times a week to feed/water/scoop. Never again!!!

Update: ate a little in the middle of the night! But not enough so I'm still syringe feeding him. Also, no BM yet... He won't eat or drink during the day! When will he get better?

excellent. you vet went old-school with the valium. 

BandZLee said:

Update: ate a little in the middle of the night! But not enough so I'm still syringe feeding him. Also, no BM yet... He won't eat or drink during the day! When will he get better?

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do you think the medication is working? oftentimes, Pepcid is used instead of Zantac. 

I don't think meds are working. Mirtazapine isn't making him hungry or thirsty. What is the dosage for Pepcid? I spent $20 on generic Zantac compound at the Pharmacy! The only think that has made him eat/drink instantly was the $40 Valium injection at the Vet yesterday. And even then he didn't eat a crazy amount, but he did eat. 

A lot of cancer and renal patients only eat with daily diazepam orally at home. GI motility can be regulated by adding metoclopramide to his regimen. I'd ask your vet about both of these. Ondansetron is a great anti-nausea med also. I use it in conjunction with Cerenia for pancreatitis cats, then stop Cerenia by day 4 and continue the ondansetron as long as nausea persists (at least 5 days). Angry pancreas take a few days to recover. Stress induced pancreatitis is the most common cause. High fat intake, trauma from impact/bite wounds, and uncontrolled diabetes are the next common causes.

Diazepam helps with the stress also, keeping them more relaxed, as well as stimulating appetite. Getting tablets compounded is a great idea for him. Also, buprenorphine at a minimum dose of 0.03mg/kg on his mucous membranes every 8 hours is the lower end of effective pain management; up to 0.05mg/kg may be needed to be effective. Many vets are too conservative and start lower, at 0.015mg/kg. Ask if there is wiggle room to increase his dose.

Ultrasound can be used to ensure nothing else is contributing to pain, anorexia and nausea.

If he already had a thorough abdominal ultrasound, with only pancreas and GI tract inflammation noted, his pancreatitis needs more aggressive therapy beyond outpatient Sq fluids and oral meds as he's been on these for many days now. Intravenous fluids, and IV anti-nausea meds, pain meds, and antibiotics may be necessary for a couple days to truly get him over the bump of resolving inflammation to get back to normal pancreatic function. Then his pancreas can once again regulate his blood glucose and his pancreatic enzymes can digest food in the intestines. Pancreatic pain is the worst, and pain alone can make him nauseous enough to refuse food, even if he is on antacids and motility meds.

Asking about pain med dose increase and more frequent administration, limiting stress/improving appetite with the diazepam, and aggressive IV therapy, in that order of priority, would benefit your current treatment plan. Hope he responds positively sooner rather than later!

puck said:

 
A lot of cancer and renal patients only eat with daily diazepam orally at home. GI motility can be regulated by adding metoclopramide to his regimen. I'd ask your vet about both of these. Ondansetron is a great anti-nausea med also. I use it in conjunction with Cerenia for pancreatitis cats, then stop Cerenia by day 4 and continue the ondansetron as long as nausea persists (at least 5 days). Angry pancreas take a few days to recover. Stress induced pancreatitis is the most common cause. High fat intake, trauma from impact/bite wounds, and uncontrolled diabetes are the next common causes.

Diazepam helps with the stress also, keeping them more relaxed, as well as stimulating appetite. Getting tablets compounded is a great idea for him. Also, buprenorphine at a minimum dose of 0.03mg/kg on his mucous membranes every 8 hours is the lower end of effective pain management; up to 0.05mg/kg may be needed to be effective. Many vets are too conservative and start lower, at 0.015mg/kg. Ask if there is wiggle room to increase his dose.

Ultrasound can be used to ensure nothing else is contributing to pain, anorexia and nausea.

If he already had a thorough abdominal ultrasound, with only pancreas and GI tract inflammation noted, his pancreatitis needs more aggressive therapy beyond outpatient Sq fluids and oral meds as he's been on these for many days now. Intravenous fluids, and IV anti-nausea meds, pain meds, and antibiotics may be necessary for a couple days to truly get him over the bump of resolving inflammation to get back to normal pancreatic function. Then his pancreas can once again regulate his blood glucose and his pancreatic enzymes can digest food in the intestines. Pancreatic pain is the worst, and pain alone can make him nauseous enough to refuse food, even if he is on antacids and motility meds.

Asking about pain med dose increase and more frequent administration, limiting stress/improving appetite with the diazepam, and aggressive IV therapy, in that order of priority, would benefit your current treatment plan. Hope he responds positively sooner rather than later!

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Here is what he is on:

Cerenia (took last dose today) has been on it for a week

Buprenorphine .18-.36 mL every 12 hours (have been doing the low end, will do high end from now on)

Mirtazapine 15 mg 1/4 tablet every other day (I feel like this isn't doing anything)

Zantac .5-.75 mls twice a day

The crazy thing is that he seems NORMAL other than not eating or drinking.  He's social, grooming, jumping into bed with me, wanting to be pet, etc.  I am about to call the vet and ask to get diazepam because that worked like a CHARM yesterday.  I  guarantee this attack was stress related, my husband is in the military and we were both out of town for quite some time (we did have a care giver come every other day.)  Do you know what the average recovery time is? 

Pancreatitis was diagnosed about 5 days after attack, his levels were on the high end of normal, which makes them believe he is on the upswing.  THANK you! Feedback has been amazing!

OH and the good news is that he hasn't vomited in 3 days!! He's definitely feeling better.  He has kept down everything that I've syringe fed him.

An average response time to therapy is 3 days hospitalization, with appetite returning by day 3-4, continuing therapy at home, with outpatient care as needed, including Sq fluids, Sq Cerenia, and assessing hydration/pain each visit, for up to 2 weeks total from initiation of treatment/therapy.

(Little note: We go for a feeding tube (esophageal tube) if no app by day 4, as this is more effective and economical than a week to 2 weeks hospitalization, and e-tubes are easily managed by owners at home, and getting food in can be an important factor to promote GI motility, normalizing GI flora, and giving stomach acid and intestinal enzymes something to digest, rather than negative side effects of empty stomach/intestines too long. Any issues with the e-tube are resolved by following detailed guide as well as just calling triage nurses to resolve blockages or change out a wrap/clean around sutures.)

Mirtazipine is typically every 3 days (every 72 hours) at the dose your vet has already prescribed; I've never been ordered by any vet to administer more often to a cat or toy breed dog, as the 15mg tab is the smallest available and their dose could only be more often if it was smaller. Too much can cause hyperactivity/dysphoria; bigger dogs take it daily just fine. The higher dose of buprenorphine may be the clincher for him, at q8 hour dosing. Oral diazepam is still a good consideration though.

Levels, i.e. pancreatic enzymes, aren't a great indicator of pancreatitis, as the amylase and lipase can increase to "High levels" just with nausea alone, after empty stomach for 24 hours, or after a couple episodes of vomit. Ultrasound is the only diagnostic to truly identify pancreatitis. Even the total quantitative tests for pancreatic lipase aren't reliable estimates, and they're boo-coo expensive.

Progress is best gauged by response to therapy, rather than amylase/lipase counts. Hydration best gauged by a cheap and fast PCV/TS. This info is more valuable than the enzyme counts.

Zantac (ranitidine) is a solid, reliable antacid. Use what you got, don't worry about switching to another one. It's in the same class as Pepcid for its purpose in treating pancreatitis, which is decreasing stomach acid and reducing risk for stomach ulcer.

In addition to diazepam, inquire about ondansetron (Zofran) for anti-nausea/anti-emitic, especially as he's finished Cerenia, and also adding metoclopramide (Reglan) for GI motility, every 8 hours. I give these separate from the antacid, so their absorption isn't affected by the Zantac/Pepcid. Motility meds help after prolonged defunct GI tract, moving digesta along at a normal rate.

Now that you know he's going to be sensitive to changes environmentally/socially, you can ask about anxiolytics to administer in the future before travel, moving, visitors, etc, as well as taking advantage of feline facial pheremone diffusers, spray, and collars.

Keeping Pepcid in stock at home for prophylactic use during potentially stressful times in the future, after you finish up the short shelf life compounded Zantac, of which 1/4 of a regular strength 10mg tab Pepcid daily would be helpful to limit over-production of stomach acid (HCl) that leads to nausea and ulcers in pancreatitis kitties. Antacids most effective when given prior to a meal, and separate from other oral meds. Pain meds won't be affected, but other GI meds, antibiotics, and endocrine meds are affected by antacids if given simultaneously.

@puck  have you encountered any liver problems in cats with daily use of diazepam ?

Ok, called Vet and the doctor that gave him the Diazepam injection wasn't there but the doc there said he doesn't think Braxton should be on it and should continue on his course of meds I just have him another (upped) dose of pain meds. I'm getting very impatient! I know I shouldn't be, but I just want him to get better. I have a one year old baby too, needless to say there's never a dull moment!

Last year my vet made me rush my 7year diabetic cat to Oradell Animal hospital in NJ due to emergency pancreatic attack. They kept him there for a week at a total cost of $9000.00 but they cured him. They gave me time to pay and the service was excellent. Therefore, Rush your pet to a good well equipped medical center that has all the facilities to help your pet. Most vets don't have the high tech equipment to cure serious ailments and most facilities will wait for payment. I also totally recommend insuring your pet in case of emergencies as this. I have a private self-funded rescue service for old and homeless felines yet I manage to insure all of them. Good luck and don't give up. Theresa

My Damian had pancreatitis last year and just had a relapse a couple weeks ago he's fine now offer him his favorites give him time he's hurting and his tummy is sensitive is he on a special diet

I have a question does anyone else's furbaby have diabetes my oldest Panther was resently diagnosed is there anyone here

HE'S EATING, HE'S EATING!!! But ONLY in the middle of the night! Is that normal? He is peeing great in the box, but I am being vigilant because if the pee spots keep getting smaller and smaller he may need more subq fluids. Yesterday was his last day on Cerenia and today is day 4 of no vomiting. Still no BM, but not worried yet because he had 2 enemas last week and combined with low appetite is to be expected. Thanks all for your encouragement! Things are starting to look up!

Well, may the increased pain management be effective towards keeping his nausea at bay, and he'll start eating.

demut, No liver enzyme elevation due to use of diazepam regularly. It's used either temporarily and intermittently, or daily at the end of life to maintain the patient's appetite as long as possible. Elevated LE's are more concerning with prolonged or high/toxic dose of NSAIDs, steroids, phenobarbital, tylenol, antifungals, few antibiotics, etc thus monitoring blood chemistry 2-3x/year if patient on any of these therapeutically. LE values can be up due to liver inflammation secondary to addison's/cushing's disease, cancer/chemo, prolonged anorexia, thyroid disease, viral/bacterial infection (ie adenovirus), inflammation of gallbladder/pancreas/GI tract, or impact/trauma.

LE's are often already monitored in patients on diazepam intermittently or regularly, by coincidence, because patients that need diazepam usually have and are scheduled for future extensive labwork, due to the disease process the diazepam is helping treat, such as epilepsy, cancer, or trauma.

Oh, I didn't see your note about his eating! That's Great BandZLee! Happy day!

Thank you! It's not as much as before, but baby steps!!!

BandZLee said:

HE'S EATING, HE'S EATING!!! But ONLY in the middle of the night! Is that normal? He is peeing great in the box, but I am being vigilant because if the pee spots keep getting smaller and smaller he may need more subq fluids. Yesterday was his last day on Cerenia and today is day 4 of no vomiting. Still no BM, but not worried yet because he had 2 enemas last week and combined with low appetite is to be expected. Thanks all for your encouragement! Things are starting to look up!

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Great to hear! I wonder if him eating only in the middle of the night has something to do with the timing of the meds. Perhaps there is a medication you're giving him before bed that makes him feel better in the middle of the night? 

What kind of food should I put him on now? Some kind of sensitive stomach food? Suggestions welcome, thanks!

What works for kitties with these digestive issues differs from kitty to kitty, it really is a trial and error thing.  I would start with a simple food, one protein and as close to just meat, liver and supplements as you can find.  Start with one food and feed for 2 weeks to see if it works with your kitty, then try another protein.  Slow is best with these kitties.  Once you find several foods that work you can start a rotation with those foods.  Foods like Nature's Variety LTD which is the most expensive, Hounds and Gatos, limited distribution and Taste of the Wild.