After many vet trips, diagnosed with Pancreatitis

Hello all, 

I originally created this account to inquire about possible opinions on what could be wrong with our 5-year-old boy Dexter. A year ago Dexter was the most athletic cat in the house, he was a physical specimen, you could see the muscles under the fur! Out of nowhere he started licking his lips often, and became lethargic, and more recently spiraled into vomiting and weight loss. We went to our primary veterinarian over a half-dozen times, trying to diagnose the cause of his chronic vomiting, 6 times a day at the worst. He also had severe weight loss, and lethargy unusual for a cat of his age. The primary vet seemed stumped on what could be wrong, and we didn't see the course of diagnosis going in the right direction, as X-rays, fecal samples, blood work ups hadn't revealed anything to the vet. So we were left giving him fluids and nausea meds. 

Eventually we took him to another vet in town that was recommended by friends, and they quickly recommended an ultrasound to check on a hunch the vet had based on his symptoms. The vet returned with a diagnosis of pancreatitis, which we were finally happy to receive a diagnosis after weeks of wondering, but quickly realized that pancreatitis is not a good diagnosis to receive. From what I understand it will be periods of him feeling good, followed by bad days where he will vomit and struggle to keep food down.

The recommended course of action from the vet was along the lines of "give him bland food, bring him in for fluids on bad days, and if you can afford it give him morphine"...Following those guidelines, the vet gave him an expectancy of two-years at most, assuming we follow a strict diet and manage his pain. I'm here to see if anyone can provide guidance, maybe you found success with a particular diet or can give some tips on how I can give him the best quality of life. I'm hoping that some others out there have had some sort of success with this issue, and can provide a little hope, everywhere I have searched has provided little hope so far.

Thank you for taking the time to look over this message, it means a lot to us! 

I know Goholistic has a kitty with chronic pancreatitis.  Hopefully she will chime in here.  I have a kitty with IBD but so far he has dodged the bullet with IBD. 

I believe she has her kitty on an anti-nausea medicine called cerenia.  He takes it for 5 days, 2 days off then 5 days back on.  It's recommended to take those breaks because it suppresses a chemical in the brain, the breaks allow the levels to go back to normal.  During bad flares her kitty was given a Fentanyl patch.

She went through a long period of trying different foods for extended periods to figure out what agreed with him the best.  I know she found one of the thickeners often used in wet foods didn't agree with her kitty.  She also gives subq fluids at home at least when he is isn't feeling well.  Fluids do seem to really help with pancreatitis.

I'm just now seeing this, @LouisClawstrong (cute username). I'm so sorry about Dexter's diagnosis. I can write something more detailed a little later. How much information do you want? I have a lot!

For now, I will leave you with this document that I referred to a lot for treatment of feline pancreatitis: https://www.idexx.com/files/small-animal-

health/products-and-services/reference-laboratories/spec-fpl-treatment-for-feline-pancreatitis.pdf.

Thank you so much@GoHolistic, that document is has lots of helpful information, I had not come across anything that in depth! Whenever you have time I would certainly like as much information as you can share that you think will help!  Just anything you have learned aside from the document from your own experiences/findings that you can add that may help with caring for him, we appreciate anything that can possibly increase his comfort. Once again, thank you for taking the time to help with Dex!

The link didn't work for me so I may be repeating information here. My cat had pancreatitis (chronic) for two years and we switched her to a hypoallergenic diet (as we suspected food allergies to be a cause - she would sometimes get little red bumps, she over groomed and rubbed her face a lot, the change of food helped all that). In addition she was on a steroid, prednisolone, because the other drug that could have been helpful - cyclosporine - made her violently ill. For a short time when first diagnosed, she was also on buprenophrine (which I am sure I have misspelled) but once the new diet was established and she was on the steroid, there was no further need for it. The downside of the steroid was that it increases the risk of diabetes. But for nearly two years, she did well, not throwing up at all, being her usual playful self, so it was worth the risk. She did develop diabetes, which we tried to control by diet and an attempt to switch to cyclosporine, this time using cerenia in the hopes that it would help her tolerate the drug that had made her so sick before. Unfortunately in her case, that didn't help. It also turned out she had another condition which had no treatment, but if it had "only" been the diabetes we could have managed.

My information may not be helpful as you and your vet will ultimately have to come up with the right treatment for Dexter. I just wanted to share my story to let you know that even if the choices you have to make have a downside (like putting your kitty at risk of developing diabetes) if it gives him a comfortable life in the meantime, it is worth it. The diabetes situation was hard, but I have no regrets about the steroid treatment as it gave her good quality of life for nearly two years. As for the expectancy, it is true that it was about two years for Bailey, but she was 10 when she was diagnosed. If Dexter responds well to treatment, given that he isn't that old and was quite healthy before, he might do better than that.

I hope you find the ideal treatment regime quickly and I'm glad you have found a vet who seems to know about this condition. I know how much it helps to have a good vet during times like this. Take care.

Sorry for the delay (and for the length of this post)! I started a draft, then got busy at work, and then lost my internet connection at home. I spared all the "Pancreatitis 101" details, but if you have any specific questions about this in a more biological sense, feel free to ask.

Chronic pancreatitis is a tough battle. Sebastian has had it for the past two years. His flares vary in severity; it waxes and wanes. I do have two questions about Dexter. How are his bowel movements? Is his vomit a watery, dark brown color?

I've outlined below how we manage it. I do always seem to forget something, though.

TO ADDRESS SYMPTOMS

• Cerenia long-term (5 days on, 2 days off) for nausea and vomiting; we couldn't do without it
• Zofran is another medication that helps with nausea and vomiting that we have used on two occasions; it is very expensive, however
• Pepcid AC for excess stomach acid; Slippery Elm Bark syrup can also be used, but it is not to be given until three hours after medications so as not to interfere with their absorption
• Buprenorphine (Buprenex) for pain as needed
• Mirtazapine to stimulant appetite as needed; I wait a couple days before adding this and also make sure he's gone at least 12 hours without vomiting and is showing signs of improvement; otherwise, adding this would be torture; Cyproheptadine is another type of appetite stimulant, but we've never tried this; syringe feed if needed (see my note in bold below)

Fortunately, we haven't had to use those last two medications in awhile.

TO CONTROL INFLAMMATION

• Prednisolone
• Curcumin
• Quercetin with bromelain
• Antioxidant therapy (vitamin E, selenium)
• Homeopathic blend
• Chinese herbs
• Subcutaneous fluids; I want to particularly highlight sub-q fluids; they can help tremendously; I learned to give them at home and he gets them every other day

TO SUPPORT GUT HEALTH

• Probiotics
• Saccharomyces boulardii
• B12 injections
• Pancreas glandular supplement
• Clay and bile salt supplement
• Digestive enzymes (maybe); I prefer plant-based unless there is a diagnosis of EPI
• Metronizdale was used the past when bacterial overgrowth was suspect, but it is not to be used long-term due to risk of neurotoxicity; Tylosin (Tylan) is now the preferred antiobiotic, and we have used this in the past, as well

DETERMINE TRIGGERS

These can be difficult to nail down, and I'm sure they are different for every cat.

• Stress has absolutely brought on a pancreatitis flare or made one worse; I keep Sebastian's environment quiet and routines consistent; refill Feliway diffusers and utilize appropriate flower essences as needed
• Temperature in the house; keep at a comfortable level with fans on low (he likes moving air)
• Keep a log book or journal; write down what you feed, supplements/medications you give, changes in Dexter's environment, etc. to see if there is something notable that he reacts to; I buy a student monthly calendar booklet, which has decent sized boxes for each day
• Other triggers for Sebastian are: high fat foods, not getting sub-q fluids on schedule (i.e., on the rare occasion that I am deathly ill), constipation, a supplement or medication that doesn't agree with him or is given in too high a dose, strong smells, over- stimulation, catnip; there are others, but I'm drawing a blank

DIET

This is really very individual for the cat. I can honestly say that I've tried everything with Sebastian - prescription foods, dry/canned combo, all canned, homemade cooked, cooked/canned combo, homemade raw, raw/canned combo, commercial raw (frozen and freeze-dried). What works best for him (or so it seems based on how he feels) is a cooked/canned combo or all canned with a fat content no more than 20% on a dry matter basis. He does get quality/premium canned foods, like Nature's Variety, FirstMate, and Lotus, for example. I've given up trying to understand it. We do try to stick with limited ingredient, grain-free, low-carb, single protein foods. The idea is for the food to be easily digestible. I feed him one protein for 3-4 weeks and then move on to something else (transitioned slowly every time). He's also allergic to guar gum. He doesn't get dry food; it's too difficult for him to digest, especially if inflammation is present.

As a side note on diet, avoiding hepatic lipidosis (fatty liver) should always be in the forefront of the treatment process. I have had to syringe feed on a few occasions. You just have to be ready and prepared to do this. I always have clean syringes on hand. If your cat is not eating, do not wait. Having fatty liver on top of everything else makes things much more difficult and life-threatening.

MORE OPINIONS & PERSPECTIVES (IF YOU CAN AFFORD IT)

I lost count, but I think I've consulted with 9 vets about Sebastian. The traditional vets mostly all have the same treatment plan and perspective. There's nothing wrong with that I guess; it is what it is. The holistic vets all had different treatment plans and different perspectives based on their specialty (Chinese medicine, homeopathy, general holistic care, etc.). Sebastian's regime is a combination of them all, and I learned something from every one of them that has helped Sebastian with his issues. I now primarily go to our local traditional vet and I consult long distance via phone with a vet that specializes in Traditional Veterinary Chinese Medicine. If you're interested, you can find one here: http://www.tcvm.com/Resources/FindaTCVMPractitioner.aspx. In my opinion, whether it's a traditional vet or holistic vet, not all vets are created equal. There will likely be some you hate and some you love. My last experience was kind of funny. I knew more than she did and she was the one asking me questions about treatment! LOL. And I still had to write her a check! 

FINAL NOTE

Not all treatments will work for all cats. Sebastian is sensitive to pretty much everything, so every introduction of / transition to something new is done ridiculously slow. I've spent two years trying this and trying that. Because I have to do it so slow, it takes forever. I'm still tweaking this and that. Most recently, he has developed abnormal stools (progression of his disease and/or lymphoma) and is on new things specifically to help with that. He won't live forever, but I have no doubt in my mind that I have given him a decent quality, and extension, of life with my efforts. I believe he's doing well right now because of everything working together (KNOCK ON WOOD!).

This thread is very helpful. My almost 13 year old female Siamese was just diagnosed with pancreatitis. Her test results were like 10x higher than what is normal for a cat. Poor girl is in a lot of pain. We've only had her for 4 months, but it feels like a decade. She wormed her way into our hearts so quickly.

The vet is going to prescribe Cerenia pills for her, and she'll start prednisolone. We've started her on a novel protein diet (rabbit) from Royal Canin. I'm keeping my expectations really low. She already has slightly high glucose levels, and I suspect it won't be long on the steroid before she develops diabetes. She also has pain in her front right paw from being declawed years ago by a previous owner. She limps a lot.

We'll just do what we can to keep her quality of life high until we can't anymore.

I kinda knew this could happen with adopting an older cat. But I do take comfort knowing that she is getting lots of love from us for however long she will have left.

munch64 said:

This thread is very helpful. My almost 13 year old female Siamese was just diagnosed with pancreatitis. Her test results were like 10x higher than what is normal for a cat. Poor girl is in a lot of pain. We've only had her for 4 months, but it feels like a decade. She wormed her way into our hearts so quickly.

The vet is going to prescribe Cerenia pills for her, and she'll start prednisolone. We've started her on a novel protein diet (rabbit) from Royal Canin. I'm keeping my expectations really low. She already has slightly high glucose levels, and I suspect it won't be long on the steroid before she develops diabetes. She also has pain in her front right paw from being declawed years ago by a previous owner. She limps a lot.

We'll just do what we can to keep her quality of life high until we can't anymore.

I kinda knew this could happen with adopting an older cat. But I do take comfort knowing that she is getting lots of love from us for however long she will have left.

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THANK YOU for adopting a senior cat and giving this old gal a loving home for her remaining years! I adopt older cats, too. 

I'm so sorry your kitty has so many problems, and now pancreatitis. Apparently Siamese are more genetically predisposed to pancreatitis, or so I've read. Cerenia will really help with the nausea, so I'm glad you're getting that. Is she on pain medication? Sub-q fluids will also help with pancreatitis, as long as she doesn't have heart problems.

I hope she recovers quickly! 

Thanks, goholistic ! I love old cats, so it was a selfish move on my part. ;-) They can be more cuddly than younger cats. We also adopted a 10 year old male orange tabby, and he smothers us with love and purrs. They're the best.

She has not been prescribed pain meds, and they gave her sub-q fluids at the vet both times I've taken her for the pancreatitis. And the new vet also gave her some B vitamins in the fluids, which I was happy about. Since my new job hasn't started yet, I've been able to be home with her a lot, so I've been feeding her wet food mixed with water every 2-3 hours, and keeping her hydrated that way. She has a tendency to excess stomach acid, so eating frequently helps with that. I'm glad that if she had to have a flare up, it happened now while I have the time of work to give her extra TLC.

She's a funny kitty. As soon as she feels a bit better (usually after cerenia), she starts jogging around. She could walk and protect her paw better, but she's too busy. Too much to see and do, birds to watch, counter tops to explore, etc. I'm glad to see some of her energy returning.

I've seen on other threads that you have a bit of experience with pancreatitis and IBD in cats. The vet prescribed 2.5mg prednisolone (half a 5mg tablet) once per day for two weeks, then we will test her again. Does that sound like a normal dose? I'm also to give her half a cerenia tablet once per day for 16 days. The vet said she hesitated before prescribing the cerenia for so much time, but since her test values were so high (almost 32, when 3.5 is usually the top of the normal range), she decided to do cerenia longer.

One other thing. Our girl has been switched to a prescription novel protein limited ingredient diet. It's Royal Canin with rabbit. She got tired of the canned version, but acts like a hyper crack addict when she sees the dry food. But if she eats kibble, she tends to swallow it whole, then can't seem to digest it and vomits it later. I started grinding 4-5 kibbles of the rabbit dry food and mixing it with her canned to keep her interested in the canned food. Thank goodness it's working so far. And I've been able to grind the cerenia half tablet and mix that with this, and she eats all of it without me needing to pill her for that, too.

munch64 said:

Thanks, @GoHolistic! I love old cats, so it was a selfish move on my part. ;-) They can be more cuddly than younger cats. We also adopted a 10 year old male orange tabby, and he smothers us with love and purrs. They're the best.

She has not been prescribed pain meds, and they gave her sub-q fluids at the vet both times I've taken her for the pancreatitis. And the new vet also gave her some B vitamins in the fluids, which I was happy about. Since my new job hasn't started yet, I've been able to be home with her a lot, so I've been feeding her wet food mixed with water every 2-3 hours, and keeping her hydrated that way. She has a tendency to excess stomach acid, so eating frequently helps with that. I'm glad that if she had to have a flare up, it happened now while I have the time of work to give her extra TLC.

She's a funny kitty. As soon as she feels a bit better (usually after cerenia), she starts jogging around. She could walk and protect her paw better, but she's too busy. Too much to see and do, birds to watch, counter tops to explore, etc. I'm glad to see some of her energy returning.

I've seen on other threads that you have a bit of experience with pancreatitis and IBD in cats. The vet prescribed 2.5mg prednisolone (half a 5mg tablet) once per day for two weeks, then we will test her again. Does that sound like a normal dose? I'm also to give her half a cerenia tablet once per day for 16 days. The vet said she hesitated before prescribing the cerenia for so much time, but since her test values were so high (almost 32, when 3.5 is usually the top of the normal range), she decided to do cerenia longer.

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Aww, so glad that you adopted a 10-year-old male, too!

Ok. Well pancreatitis is very painful, so if your cat still seems to be struggling or is "meatloafing" a lot, you may want to ask the vet about pain meds.

2.5 mg of pred once a day is a low dose based on my experience. When Sebastian was first put on prednisolone, we started at 7.5 mg a day (that was a compromise; vets usually want to start at 10 mg). We stayed at that dose for two weeks, I believe, and then went down to 5 mg a day. When we tried to bring it down to 2.5 mg, he flared up again, so we stayed at 5 mg a day. But I know you said that she already has glucose numbers on the high end, so that might be why your vet is doing such a low dose.

For the Cerenia, Sebastian's flare dose was 1/2 tablet and his maintenance dose was 1/4 tablet (always once a day, Monday through Friday). He was on Cerenia for 2.5 years with no side effects. The only harmless side effect he ever had was hypersalivation on the 1/2 tablet dose. It is one of the listed side effects.

The addition of curcumin to his regime also really helped keep his flare-ups under control.

munch64 said:

One other thing. Our girl has been switched to a prescription novel protein limited ingredient diet. It's Royal Canin with rabbit. She got tired of the canned version, but acts like a hyper crack addict when she sees the dry food. But if she eats kibble, she tends to swallow it whole, then can't seem to digest it and vomits it later. I started grinding 4-5 kibbles of the rabbit dry food and mixing it with her canned to keep her interested in the canned food. Thank goodness it's working so far. And I've been able to grind the cerenia half tablet and mix that with this, and she eats all of it without me needing to pill her for that, too.

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I do understand the frustrations and challenges with diet for these kitties with health issues. It can be a real struggle, to say the least, to find something that they will eat that also makes them well again. My personal opinion is to rotate quality canned, homecooked, and/or raw that is easily digestible and tolerable to the cat (both in palatability and in how they feel). Dry food can be difficult to digest, especially when inflammation is present. I also learned that the Royal Canin Selected Protein dry formulas now contain soy. It's important to keep them eating, though. So if grinding the dry food and using it as a topper works right now, then fine. You might save yourself some time by using a coffee grinder.

Thanks for responding so quickly, GoHolistic.

She has an upset tummy again right now, and is on the prowl for something to eat that will make her vomit. She got the half cerenia tablet 3.5 hours ago, but it hasn't kicked in yet. I'm debating giving her another half tablet, and will call her vet. She doesn't want to eat her canned food, even with a generous sprinkling of crushed kibble on top. I put some fortiflora on it, but I know that sort of invalidates the novel protein trial diet, since I don't know what kind of animal digest is in it.

Yeah, food is such a tough question. I struggled to find commercial food that she could tolerate. She threw up or had diarrhea with some foods I tried for her, and it seemed anything with corn or wheat bothered her tummy. The Blue Buffalo/Wellness type stuff with all kinds of veggies and berries in it gave her trouble and she didn't really want it, either. I had finally gotten her sort of comfortable with Nutro soft loaf canned for seniors and their chicken and brown rice dry food, and she was OK for the longest stretch she'd had (about 2 weeks with no diarrhea or vomiting), when this pancreatitis flare up happened. Poor girl.

munch64 said:

Thanks for responding so quickly, GoHolistic.

She has an upset tummy again right now, and is on the prowl for something to eat that will make her vomit. She got the half cerenia tablet 3.5 hours ago, but it hasn't kicked in yet. I'm debating giving her another half tablet, and will call her vet. She doesn't want to eat her canned food, even with a generous sprinkling of crushed kibble on top. I put some fortiflora on it, but I know that sort of invalidates the novel protein trial diet, since I don't know what kind of animal digest is in it.

Yeah, food is such a tough question. I struggled to find commercial food that she could tolerate. She threw up or had diarrhea with some foods I tried for her, and it seemed anything with corn or wheat bothered her tummy. The Blue Buffalo/Wellness type stuff with all kinds of veggies and berries in it gave her trouble and she didn't really want it, either. I had finally gotten her sort of comfortable with Nutro soft loaf canned for seniors and their chicken and brown rice dry food, and she was OK for the longest stretch she'd had (about 2 weeks with no diarrhea or vomiting), when this pancreatitis flare up happened. Poor gi

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Oh no!     Please call your vet again first. It is my understanding that a whole tablet of Cerenia would be an overdose. It's not the kind of medication you can just give again if you don't notice it working. Also, ask the vet about his/her thoughts on the pred dose and maybe incorporating some other things to get her feeling better (Pepcid AC for stomach acid, buprenorphone for pain, etc.). If the cat doesn't get overly stressed at the vet, you could take her back in for sub-q or IV fluids. These kinds of fluids are different than just adding water to food. They contain electrolytes and seem to help them feel better overall and also "flush out" inflammation.

Nature's Variety Instinct has a canned rabbit that seems to work well for many kitties with digestive issues. Tiki Cat's Puka Puka Luau is a simple shredded chicken canned food (if she's not allergic to chicken). Both of these foods are low fat and have no thickeners/fillers, so I would consider them easy to digest.

goholistic , you are wonderful. Thank you for your replies.

I called the vet, and she didn't mention another half tablet of cerenia being an overdose amount, but she did tell me not to give it. Thanks for letting me know that.

I got her to eat a little more ground up kibble, and mixed the pred in with it, and she finished it and has kept it all down.

I'm pretty sure my cat would murder me if I took her to the vet again, and since she hasn't actually vomited, I am not as concerned that she's dehydrated. I agree with you about the sub-q liquids. They help perk her up. Maybe I should learn how to administer them at home. Especially if this turns out to be chronic.

I should've been more specific about her tummy upset. It's bothering her and she isn't eager to eat. She's been looking for stuff to chew on that will make her throw up. But no vomiting or diarrhea. (So far).

Last thing--it seems to matter to her WHERE I feed her. For some reason, she's become disinterested in food downstairs, but if I give her the same plate of food upstairs, she'll eat it.

Cats are weirdos.

Supposedly, the pred may make her more hungry and thirsty. That would be nice.

I am so sorry - it is a horrible and distressing condition to deal with. But there can be a positive outcome. My daughter's cat MIna had a terrible bout with pancreatitis and we really thought she would make it. But four years later Mina is healthy and happy, and with regular vet checks and a grain-free diet, is living a normal life. Here is her story:

www.thecatsite.com/t/252412/mina-is-very-sick

That's wonderful, jennyr ! I just read the whole thread. What a difficult ordeal that must've been for your daughter--so many changes. And for poor Mina, leaving the vet hospital and coming "home" to a new house. But they both proved to be resilient.

My kitty is doing OK today, but I feel frustrated, because she is developing an aversion to the canned wet food. She only wants kibble, and that's not great for her sensitive digestive tract.

We just keep taking it one day at a time.

@munch64, how is your kitty feeling?

Hi goholistic ,

I was just about to post an update and saw you asked about her! Thanks for your concern.

Positives: she is still obsessed with watching pigeons eat out of the feeder at her window in her favorite room. She jumps up and down off her bed and runs around stalking them through the window. She is eating her kibble, about half a cup per day.

Negatives: she doesn't want to eat her wet food anymore. I've been using a tiny bit of it to get her to take her crushed up meds. It's so frustrating to get her to eat it. Just now, I took the little 1/2 tsp of medicated food and fed it to her in a syringe instead. She didn't fight it or spit it out so far, so I'll keep doing it because it's easier than following her around with her plate trying to tempt her.

She is still on half a tablet of cerenia per day, and 2.5mg of prednisolone per day.

I do get the sense that she's in pain. She doesn't have her usual spark. She hadn't been cuddly, nor has she sought out affection like she normally does. She is keeping to herself and the pigeons. I am tempted to take her to the nearby vet and see if they can just give her some sub-q fluids (which I know you're a fan of). But they will probably want to examine her and whatnot since they are not up to speed with her treatment for this. Her regular vet is awesome, but a 40 minute drive away. That's a long way to go for fluids, but it may be worth it.

You're welcome! It sounds like you're doing the best you can. It's better that she eat something than not eat anything at all. Did you consider trying that other canned rabbit food I mentioned? Sebastian used to turn his nose up to a lot of wet foods when he wasn't feeling well. If you're up for giving fluids at home, you could ask your vet about that. They gave me a little training session at the vet with Sebastian. I was nervous the first time, but quickly got the hang of it. I eventually was able to give 100 ml of sub-q fluids in about 3 minutes. I did use the larger needles though, so the fluids flowed faster. And if you feel she's in pain...well...I know I already mentioned pain meds. If you're nervous about pain meds, ask the vet about a low dose just enough to "take the edge off" so to speak.

I don't want to jinx our situation, but our sweet girl is doing pretty well still. I'm used to her cycling quickly between good and bad, so I feel like I'm waiting for the other shoe to drop.

She is still getting 2.5mg prednisolone per day, and half a cerenia tablet. She has stopped taking them in her food, so I've had to grind them both up and mix with a tiny bit of water (which makes them dissolve), and then I sneak attack her and give her the syringe of meds once per day. The vet said this was fine.

She has not vomited since her initial flare up on May 18. That's about 2.5 weeks. She has had softer stool than normal today, and I hope it's just because she snuck two bites of her brother's chicken based food, and she's supposed to be having only rabbit these days.

She has an appt on Thursday with the vet to test her pancreatitis level again. Then we'll make decisions about the meds, and I'll get them to give her some sub-q fluids again.

She's got energy, and while she isn't quite as playful as she was 5 months ago when we got her, she is not lethargic.

Fingers crossed.