Cat with pancreatitis.. advice?

OK - so I am new here.. I was referred here by someone, was told there are knowledgeable people on this board. I was on another board looking for advice, but didn't receive much input. So this is a bit after the fact. My cat went to the vet last week for diarrhea. She first had it on Tuesday and I brought her in finally on Thursday, same day she lost her appetite. At the vet she gave her an injection of Centrine, B vitamin, and fluids.. and she sent me home with pro-pectalin. I brought her home gave her food, she licked a bit, so I went to work to finish my day. I came home to a very lethargic depressed cat, not eating, who had vomited three times (mostly digested food), no interest in even her favorite treat. She seemed to be miserable and she also seemed a bit hot. So I brought her in - 105.1 fever. After some tests (some of which were messed up in the lab, adding additional worry to me) - lab work and an ultrasound - the u/s showed slight pancreatitis. Everything else appeared normal and her labs were normal. While hospitalized they gave her IV fluids, antibiotics, anti-nausea, metronidazole, buprenorphine, all things to help her GI tract feel better and to hydrate her. She was there two nights. When she left Saturday mid-day she was a bit out of it. They gave me liquid metronidazole (big mistake) and buprenorphine for any discomfort. I only gave the pain meds once because they had weird side-effects. Decided I'd give them only if needed, if she seemed painful. Since she's been home I've given a couple doses of metronidazole, with which she drooled most of it so I doubt she got much in her. She has been eating really well, no vomiting. Her diarrhea has stuck around, but she seems to only be going once daily. She hasn't lost any weight since her thursday appt (i weighed her on my scale today). Overall - she's doing well! I took her temp today, normal. So now I just wonder if anyone has experience with pancreatitis. I know I've read that it  often isn't accompanied by diarrhea (or vomiting).. so in the back of my mind I worry about IBD. But this was the first time she's ever had diarrhea like this.. So I don't think there is enough history to make that determination. She also isn't one to frequently vomit, and always has a great appetite. It also crossed my mind that MAYBE she had a reaction to the Centrine injection the rDVM gave her earlier. Don't think she'd ever had it before.. But either way.. I wonder if it's possible that this is it? Was that the worst part of the pancreatitis, which I assume is considered acute.. or could I expect her to get sick like that again, fever and vomiting? Is there anything special I can do to get her back to normal health? Currently I am feeding her regular diet, Friskies canned, plus some fancy feast and Sheba also - all canned. They have gotten all this food before, nothing is newly introduced. I have been thinking about switching to grain free canned, but I don't want to do that during an episode. I will look into it when I know she's recovered. 

Today I contacted her rDVM and got the pill form of metronidazole... she also gave me baytril just in case there is anything else going on. She gave me pred, but I think I will hold off on that. I've heard putting them on that can cause issues with reoccurrence if it's IBD. Don't want to risk it now, unless it's absolutely needed. I also got some pet tinic, because she was slightly anemic (per tests) and I noticed her gums are less pink than normal. I will probably give her pro pectalin too to help her GI issues. So now time will tell.   If anyone else has any suggestions though, experience with pancreatitis, I would love to hear your input. Thank you in advance!

Hi @stellar981. I'm sorry your kitty has been unwell.     How old is she? I managed chronic pancreatitis and IBD in one of my cats for nearly three years before he eventually succumbed to heart failure. I'm about to go to bed, but I wanted to respond with some initial thoughts.

I'm a little unclear as to how your kitty is doing right now. Halfway through your post, you said she's doing really well, but you still seemed concerned and I'm getting a vibe that she's still not quite herself. How has she been the last couple of days?

Pancreatitis is essentially a form of IBD of the upper GI tract. Most people associate IBD only of the lower GI tract when diarrhea is present. Given your kitty's symptoms, it seems to me that she is showing signs of both. (Disclaimer: I am not a vet and this is not a diagnosis.)

I'm not too familiar with the use of Centrine. It doesn't seem to be something I've heard used often in these cases. Since your cat had diarrhea before receiving the Centrine injection, that probably isn't what caused it. There is a well-known medication called Cerenia that is used by many for vomiting and nausea. It works great. Many vets send clients home with the tablets and is usually used as needed. My cat was on it long-term (5 days on, 2 days off) without any issues.

Metronidazole is an antibiotic with anti-inflammatory properties, and it's not really effective to be given here and there. It's usually given for two weeks or so uninterrupted to address any underlying infection and to help with inflammation. It does not address nausea directly. It shouldn't be used long-term. I like to supplement with probiotics to help rebuild healthy gut flora, especially when antibiotics are being given.

Baytril is another antibiotic and needs to be dosed correctly and carefully. In my opinion, unless the blood work showed a significant elevation in white blood cells (indicative of an infection), I personally think administering two antibiotics is overkill. Antibiotics can do more harm than good by throwing the GI tract totally out of whack by killing off all the bad bacteria as well as all the good.

Buprenorphine is a strong pain medication usually used as needed. Pancreatitis is extremely painful.

If you think you cat is reacting negatively to any of the medications, do let your vet know. Some cats do not tolerate metronidazole, and some cats need buprenorphine at a lower dose to curb the pain but with less intense side effects.

The slight anemia is a little bit of a concern. Administering B12 injections can help with mild anemia, as well. Ask your vet about giving the injections at home. They can show you and it is easy once you get the hang of it.

As for diet, I would personally upgrade the food to a better brand. I understand that Friskies and Fancy Feast have been what you always fed. Unfortunately, as our kitties get older, sometimes they just can't tolerate certain foods anymore, even if they've been eating it all their life. If you're feeding canned, I would probably reach for Nature's Variety Instinct first. Many cats with GI issues seem to do well with that brand, especially the rabbit formula. Go! brand and Lotus Just Juicy are also well-received. Do you suspect any potential food allergies? Of course, there's always commercial freeze-dried raw options and making homemade food (raw or cooked), which for some people was the only change they needed to make. I do recommend switching foods slowly. Start by mixing a small amount of the new food in with her old food and gradually increase over a 1-2 week period to avoid further digestive upset.

I think if I were in your shoes, I'd do the following: Administer sub-q fluids at home every four days (my cat's pancreatitis really benefited from fluids) as long as she doesn't have a heart condition, administer B12 injections at home every week, give slippery elm bark syrup twice daily (at least two hours away from food and medications) to settle the tummy and possibly help with diarrhea, have Cerenia on hand for nausea and vomiting, have buprenorphine on hand for pain, slowly introduce probiotics (including a specific type called saccharomyces boulardii), and upgrade to a better food.

If there is a holistic vet you can work with, he/she might be able to provide another perspective and some new ideas. It should be a collaboration between you, the traditional vet, and the holistic vet. I firmly believe in an integrative approach.

Sorry my post ended up longer than anticipated! I'd like to end this with links to two older posts - the first from a long-time TCS member with a lot of knowledge on these topics, and the second is from me on another pancreatitis thread. Warning: it will be a lot of information to digest. Try not to get overwhelmed. Best to start with the basics and go from there. 

http://www.thecatsite.com/t/278273/...-or-lymphoma-and-pancreatitis/90#post_3576295

http://www.thecatsite.com/t/303763/after-many-vet-trips-diagnosed-with-pancreatitis#post_3812660