Potential Chronic Pancreatitis?

[10thomer]

I'm starting a new thread for a couple of reasons:
1. To share what I've learned in case it's helpful for anyone else
2. To ask a couple of questions in case someone has more visibility into my cat's potential situation

Long story short, my 5 year-old cat (otherwise healthy, muscular, proper weight for how long he is) was throwing up every 4-5 days for a couple of months. This was not surprising because we suspected that he had upper tract IBD and his sister (who we also own) has lower tract IBD. We've been able to control symptoms by feeding high quality wet food, but he has been known to have flare-ups. But we decided to take him to a vet, because his latest flare-up was lasting a relatively long time.

Vet visit #1: Blood test shows high creatinine (2.3), slightly elevated SDMA (15), and totally normal BUN. Urinalysis shows slightly low urine specific gravity (1.019). I freak out because I think my 5 y.o. cat may have CKD or some acute kidney distress.

At this point I begin mixing water into his wet food, which seems to substantially calm down his vomiting.

Vet visit #2 (1 month after visit #1): Ultrasound (performed by a specialized technician) shows a totally normal set of kidneys, but inflamed upper GI tract. Helps to confirm suspicion that cat has IBD but no support for CKD. Cat is still intermittently throwing up, but not as often as before.

Vet visit #3 (1 month after visit #2): Blood test shows even higher creatinine (2.6), SDMA test fails due to lab error, but BUN remains totally normal. Urinalysis shows improved specific gravity (1.030) which to my understanding is a normal number for a cat who only is fed wet food.

I freak out even more about the rising creatinine. I try to slowly switch him to kidney-friendly foods, and this sets off his IBD. He vomits almost every day for a couple of days, I switch him back to his normal food, but the vomiting continues. Vomiting is (and always has been) clear liquid with nothing in it, and almost always happens in the late afternoons. I begin feeding him 4x's a day, with an additional time around the later afternoons when he normally vomits. Vomiting stops with the exception of a hairball.

Internal Medicine Specialist Visit (1 month after visit #3): Creatinine has decreased back to 2.3 and BUN remains totally normal. Everything else looks great, but a new biomarker the specialist tested for, fPL which is an indicator for pancreatitis, is 2x the reference range. Specialist looks back over ultrasound results and sees that the pancreas was not inflamed. Specialist thinks my otherwise healthy 5 y.o. cat has IBD, chronic pancreatitis, and CKD.

I refuse to believe my young cat has 3 chronic diseases, so I do a little researching. There is a link between IBD and pancreatitis because of the structure of these organs, so this isn't that surprising to me. I see on Tanya's sight that there's a potential link between cats with mildly elevated creatinine and pancreatitis. However, to make matters more confusing, there's also data to suggest that CKD cats can have falsely elevated fPL, the biomarker for pancreatitis. Which leads me to my questions for the community:

1. Based off of this data (and always happy to provide more data if it's helpful), does it seem more likely that I have a cat with pancreatitis, CKD, or both pancreatitis and CKD here?
2. Does anyone have any experience with cats with pancreatitis having elevated creatinine? If so, did they also have elevated BUN?
3. Does anyone have advice for treating a cat with chronic pancreatitis? This new feeding schedule is helping a lot, but would love to hear any other potential tips you all have gathered.

Hope this ends up being helpful even though I don't have a *super* conclusive diagnosis here!

 

[daftcat75]

I don't have any experience with CKD. Sadly, I do have experience with pancreatitis in my Krista.

My back of the napkin estimates of what's going on with your guy:

a. Inflammation in the gut can spill over to other organs. It does not surprise me that he has pancreatitis to go with his IBD.

b. The kidney numbers are mild elevations. I believe these are much more suggestive of dehydration from all that vomiting rather than true markers of kidney disease. If you aren't seeing other signs of kidney disease like excessive dilute urine and excessive thirst (and other symptoms I know I am missing because I've never had a CKD cat), then I would set these abnormal readings aside. Re-test them in a month or two when you re-test his fPLI (pancreatitis.)

c. Focus on the pancreatitis. That's job one here! Keep him eating. Have him eat his way back to good health. Please don't hesitate to ask for anti-nausea and appetite stimulation medications if he needs help eating. You can get both of these compounded to more desirable dosing forms if your cat is resistant to taking medication (like just about every other cat!) Wedgewood Pharmacy is a wonderful compounding pharmacy. Your vet calls in the prescription and you can decide what formulation to use. You can get most medicines compounded into flavored liquids or chew treats. Some medicines can also be compounded into transdermal forms.

d. Keep a food journal of what you feed, when you feed it, and if it caused a reaction (vomiting or abnormal stools.) If you're feeding dry food, try to avoid that altogether. Dry food and pancreatitis are pretty much incompatible. All those nonsense carby ingredients in dry food are very difficult for a healthy cat pancreas to digest. Ultimately, to be successful with both IBD and pancreatitis, you need to identify triggers and eliminate them.

e. Ask your vet about B-12 shots. These are usually necessary for IBD and pancreatitis cats. These are easy enough to administer at home. You can search YouTube to see how to do it. You'll get good at it and the cat won't even notice if you do it right. You'll need a prescription from your vet and it would be helpful if the vet can sell you the supplies you need (the B12, syringes, needles, and Sharps disposal for your used needles.)

f. Clear vomit without food is the easiest kind to fix. That's stomach acid. Your poor guy is having a hard time going so long between meals. You already found the fix: smaller, more frequent meals. In the wild, cats would eat up to a dozen meals a day. You can use timed feeders to feed when you aren't going to be awake or around to offer a meal.

If I have to leave you with the most important points, it would be this: if and when he starts vomiting food instead of just stomach acid, that's when you need to put on your detective hat to figure out the trigger foods and possibly consider elimination diets or limited ingredient diets. As long as he's just vomiting stomach acid, do what you're doing: more frequent meals. Keep him eating even if that means medication. And B-12 shots! B-12 shots are one of the most important components to recovery from both IBD and pancreatitis.