Sebastian Hospitalized, Has Pancreatitis - Seeking Input

[goholistic]

Hi all,

Sebastian, my beautiful, long-haired boy (picture in the avatar), has had a bumpy road lately, and the latest has me devastated. I am physically ill about this. I'm sorry this is so long, but I know some of you like the medical details.

SEBASTIAN'S HISTORY:

Calicivirus, feline herpes virus, occasional upper respiratory infections, all managed successfully with a decent diet and L-lysine. Never any major issues. Also has (had) dental disease.

RECENT CHALLENGES:

5/30 - Bloodwork; ear infection; prescribed Tresaderm.

7/2 - Dental cleaning and six extractions (vet changed policy and did not administer pre or post dental antibiotics)

7/7 - Sutures came out on removed upper canine tooth; Sebastian in discomfort and wouldn't eat, took him to the after hours ER where they prescribed oral Clindamycin (antibiotic for dental issues) and a Fentanyl patch for pain.

7/8 - Brought Sebastian back to regular vet; gave sub-q fluids; ordered to discontinue Clindamycin to avoid more trauma to the mouth; instead gave antibiotic injection. Did not re-suture socket, wanted to see it fill in on its own with daily cleaning by me with a syringe. Sebastian started eating on his own and mouth was healing nicely.

DISASTER STRIKES:

7/22 - Came home from work to find vomit EVERYWHERE. Sebastian vomited at least 12 times that night.

7/23 - Took him to the vet in AM. Bloodwork showed neutrophil count was sky high (25,000). Doc suspected pancreatitis and ran the specific pancreatic lipase test. Came back positive. Hospitalized overnight to treat symptoms with IV fluids, Covenia (antibiotic), Cerenia (antiemetic), Pepcid AC and Fentanyl patch. Nurses and docs continuously kept me updated on his progress. Said he was comfortable and resting.

7/24 - Sebastian has a fever of 103.9. Continued with IV fluids, Cerenia and Pepcid. Ordered abdominal x-rays, which showed inflammation and thickening of the pancreas and some intestinal loops. Possible lymphosarcoma (GI cancer). Fever returned to normal by PM. Continued hospitalization. No interest in food.

7/25 - Took Sebastian to a specialty center for an ultrasound. Specialist didn't see anything overly alarming, no masses, and very small chance of cancer. Pancreatitis seems to be on the mend with no obvious thickening. Docs said to take him home and see if he'll eat (still hasn't eaten since Monday). Gave appetite stimulant. Sebastian still won't eat.

7/26 - Back to the vet for sub-q fluids, Cerenia, Pepcid, and Flagyl (antibiotic for GI issues). Doc checked liver enzymes (since he's still not eating) and they were remarkably still okay. Nurses called in afternoon to say he was eating a little of what they had there (Kitten Chow and 9Lives tuna). I picked him up after work and tried to feed him what they were feeding him. Had a couple bites of Kitten Chow but no wet food.

7/27 - Ate about 2 tbsp Kitten Chow in AM. Still did not want any wet food. Offered a little tuna fish in the afternoon and he ate that. PM - really no interest at all. Took a couple licks of a different wet food, a couple morsels of dry and that was it.

Sebastian slowly seems like he's coming around. He's alert and walking around the house. He was laying on his back today with his belly in the air, so he must not be in too much pain. At this point, I don't know what to do about the eating. They gave me some A/D for "assist" feeding, but I'm afraid it'll give him food aversion. I've tried a bunch of junk wet food (Friskies, Fancy Feast, 9Lives, Whiskas) and he doesn't want any of them. My mom brought over Purina One, but he doesn't want that either. I picked up three other brands of dry food today, and he turned his nose up at every one. Do you think he's still nauseous?

Given his history, I'm almost tempted to think the pancreatitis was caused from all the previous challenges. Hopefully, this is just acute pancreatitis and not chronic. And hopefully it's not cancer.

Does anyone have any suggestions on why he still wouldn't be eating if he's feeling better? Do you think assist feeding will make his food aversion worse? And what possibly could have caused the pancreatitis? Or any other thoughts you may have on any of the above. Thank you.

 

[vball91]

I am so sorry for all that you and Sebastian are going through. The causes for pancreatitis in cats aren't really known at this point, so worrying about why or if it could have been prevented isn't really helpful right now if that makes sense. All you can do is focus on helping Sebastian through this which it sounds like you are doing. Many cats have suffered an attack of pancreatitis and then no other episodes.

If Sebastian is still not eating enough on his own, then I would absolutely assist feed. The key to avoiding food aversion is to use anti-nausea drugs like Cerenia and an appetite stimulant like Cyproheptadine. You definitely want to treat for nausea because just using an appetite stimulant or syringe feeding while the cat feels nauseous creates the negative association. Although most cats don't enjoy syringe feeding, they don't normally develop food aversion from it. It's also good to use a different food like a/d which isn't his normal food in case he does have some negativity toward the whole process. It is important to stay calm and explain what you're doing and why.

Carolina has a good video on how to syringe feed. Also LDG had a very recent thread on pancreatitis with some background research into pancreatitis that you might find helpful.

 

[goholistic]

Thanks so much for your input. I tried giving him food one last time tonight, but it was a no-go, so I decided to assist-feed. I found a helpful "tutorial" online and it seemed to work. He (and me) stayed calm and he didn't even run away or hide afterwords. He only walked away a couple feet to clean his face and then came back to get some loving. After mixing the A/D with water, I was only able to get about 1/8 of a can into him, but he did eat a little on his own this morning, so I figured that was enough for today. I also added a little extra taurine (approx. 170 mg) to the A/D mixture.

This whole pancreatitis thing is so frustrating. I feel so helpless. I have probably lost 5 pounds in the last week just from the stress of it all. I'm distraught that this is happening to such a sweet cat.

Anyway, I do have some mirtazapine on hand, but he isn't due for it again until tomorrow. Although, when I gave it to him on Thursday, it didn't do a darn thing. I think the Cerenia was more helpful, so I have to talk to the doctor about that on Monday. I could also give him a 1/4 tablet of Pepcid AC, but I'm not sure if that would be of much help.

 

[vball91]

Definitely talk to the vet about Cerenia. Sometimes, when you treat the nausea successfully, you don't need the appetite stimulant. For app stimulants, there are two that work well on cats, Mirtazapine and Cyproheptadine. Generally one or the other works better on each cat, so if the mirt does not seem to be doing much, ask for cypro instead.

Pepcid works on excess stomach acid, so if that is a problem, it can be helpful.

I'm glad the syringe feeding went well. You want to aim for 1/2 to 2/3 of his normal caloric intake in order to prevent hepatic lipidosis.

 

[goholistic]

Thanks, I will. And I'll ask about Cyproheptadine. The vet said for Sebastian's size, he should get at least 1/2 can of A/D per day divided into 2-4 feedings if he's not eating anything else. That seems like so much. I don't know how I'm going to do that during the week. I work full time, which means the best I could do is 3 feedings - morning, after work and before bed - and that also means it would be more than 1/8 of a can at one time. Ugh...
 

 

[carolina]

Hi
How much does he weight?
1/2 can sounds too little..... unless he is a tiny cat, I would be looking into at least 2/3 of a can.
Keep in mind A/D is syringe ready - and the more you dilute, the more you have to feed :nod:

A great thing to do is to get a cat bag - go to Amazon and search for one - the Cat Sack is a great one, and Kats Klaws (I think that's it) is a nother GREAT one.

Prepare all your syringes in advance - I like feeding 1oz - 1.5oz per meal. My syringes are 0.5 oz, so I have either 2 or 3 syringes per feeding, ready.
Aim to the roof of the mouth, feed 2-3ccs at a time, wait for him to swallow and feed again. Keep yourself calm and do it some what quickly.

It is IMPERATIVE that he eats well. The LAST thing you want is for him to develop fatty liver disease on the top of the pancreatitis - that can turn into Feline Triaditis, which can be very, very dangerous. You don't want to go there.

Here is a thread I put together with a bunch of tips and helpful links - the video is on post #7
Syringe Feeding Lucky Video/If your Cat is not eating

As for the feeding during the time you are working - feed early in the am, right when you get back from work, and before you go to bed.
Leave some food - I would leave some freeze dried chicken out - it is 100% chicken breast - calorie packed and no junk, low fat, for him to munch through during the day.

I like Cyproheptadine - it works very well, and so far none of my cats have had side effects - it takes a day or so to kick in, and it has to be given twice a day. It is very reliable though. Cerenia is fantastic.

If you can not do the feeding - don't wait - GET A FEEDING TUBE ON.

Good luck

 

[maewkaew]

You have got a lot of good advice on here.  

  VERY important that you do get food into him.   Believe me , you do not want him ending up with liver damage from not eating enough. .   Pancreatitis is probably the most common cause of hepatic lipidosis in cats.  

something  that is a smooth pate and high in calories , like the  Hills AD or  Wellness Chicken or Turkey.   Wellness is actually a bit higher in calorie than AD  and better quality  .   

 I would try to get at LEAST 3/4 of a  5.5 ounce can into him daily,  in several small meals.   better if you can get a whole can.   I mix it with some warm water . both to  make it easier to deal with in the syringe,  and to improve hydration. 

 I like to use a large feeding syringe.  and I fill it by totally taking the plunger out and then stuffing the food into that end , pushing it down with a knife or something 

 I agree about the anti-nausea,  anti-acid,  and appetite stimulant.   but don't give the appy stim w/o the anti nausea if you think he is nauseated. that would just be miserable.  

Other thing is,  pancreatititis is usually very painful  and cats have shown improvement when given pain med even if they did not show obvious signs of pain on palpation by the vet.  ( because they HIDE  pain so well .  but it still affects them.    

     So you might want to get some pain med like  buprenorphine if he does not already have some.  ( If you get that,  remember it does not work if he just swallwos it right away.  It needs to be givenvery slowly into the cheek pocket so it can be absorbed into the lining of the mouth. 

 It is a balancing act though,  because in some cats that could decrease appetite.   but in others,  relief from pain may make them more able to eat. 

 Subcutaneous fluids can also be a useful weapon in the arsenal.  both to replenish fluid loss and I think also helps to flush out inflammation.   I always did SQ fluids during  bad Pancreatitis attack. 

This has some good links to papers about treatment   http://www.felinecrf.org/pancreatitis.htm

  Hope Sebastian will be getting better and totally recover.    I have been through this multiple times with my Louis who had chronic pancreatitis for years.   ( but he was not sick all the time.  most the time he felt pretty decent  considering all his health problems.   ) 

 

 

 

 

 

[goholistic]

Thanks all. As of 7/26, he weighed 12.02 lbs. The vet gave me small syringes with a tiny tip, so I am not able to suck up the A/D unless I add water. I can ask or look for a bigger syringe. Carolina, did you not add any water to it at all? Maewkaew, filling the syringe through the top and pushing it down is a good idea. Maybe I'll try that next time.

He did eat a little dry food this morning that I fed to him by hand (maybe 1/2 tbsp). But knowing that is not enough, I prepared the syringes for assist feeding. Again, he could only withstand 1/8 can. We were calm, but I can tell he doesn't like it. He acts hungry, like he came into the kitchen this morning and got all excited when he heard me preparing breakfast for them. But then when I put down different foods, he doesn't want anything, which makes me think he's still nauseous. With the assist feeding, it is best to do it in a room where the cat doesn't normally eat. My three cats have "stations" in the kitchen where they eat. Does this mean I shouldn't assist feed Sebastian in the kitchen?

I'm sure the vet is going to want to see him again this week, and we'll decide about the feeding tube. I think my vet prefers naso-gastric tubes. Does this hurt the cat? Will it be traumatizing for him? I really do think he's starting to feel better, but it's slow and my expectations are too high. He was all sprawled out yesterday laying on his back with his belly in the air, so it doesn't seem like he's in much pain. But I can certainly ask about another Fentanyl patch. They are relatively cheap and last for three days. My heart just drops every time I see him turn away from his food. My poor, sweet boy. 

 

[vball91]

Go to a pharmacy and ask for large oral syringes. My Walgreen's didn't even charge me for them.

Going to the food bowl and then turning away is a classic sign of nausea. He's clearly hungry and wants to eat, but something is stopping him, so Cerenia or Ondansetron is a must I think.

 

[goholistic]

Thanks. I will stop at Riteaid or CVS today and ask for large syringes.

I agree that he needs Cerenia, and plan to ask the vet about that first thing tomorrow morning. I read that it shouldn't be taken long-term due to it causing tremors, so there should be a 1-2 day break in between dosings.
 

 

[carolina]

Thanks all. As of 7/26, he weighed 12.02 lbs. The vet gave me small syringes with a tiny tip, so I am not able to suck up the A/D unless I add water. I can ask or look for a bigger syringe. Carolina, did you not add any water to it at all? Maewkaew, filling the syringe through the top and pushing it down is a good idea. Maybe I'll try that next time.

No, no water at all - A/D is syringe ready. These are the syringes I use - you can find them at Petco and Petsmart - they are fantastic. I use the one on the right specially, so buy a few sets. Just remove the plunger and fill from the top with a spoon. Put the plunger back and you are ready to go.
He did eat a little dry food this morning that I fed to him by hand (maybe 1/2 tbsp). But knowing that is not enough, I prepared the syringes for assist feeding. Again, he could only withstand 1/8 can. We were calm, but I can tell he doesn't like it. He acts hungry, like he came into the kitchen this morning and got all excited when he heard me preparing breakfast for them. But then when I put down different foods, he doesn't want anything, which makes me think he's still nauseous. With the assist feeding, it is best to do it in a room where the cat doesn't normally eat. My three cats have "stations" in the kitchen where they eat. Does this mean I shouldn't assist feed Sebastian in the kitchen?

I'm sure the vet is going to want to see him again this week, and we'll decide about the feeding tube. I think my vet prefers naso-gastric tubes. Does this hurt the cat? Will it be traumatizing for him? I really do think he's starting to feel better, but it's slow and my expectations are too high. He was all sprawled out yesterday laying on his back with his belly in the air, so it doesn't seem like he's in much pain. But I can certainly ask about another Fentanyl patch. They are relatively cheap and last for three days. My heart just drops every time I see him turn away from his food. My poor, sweet boy. 

No, a feeding tube will not hurt him, and on the contrary - it will take the stress out of feeding. It will also ensure he is getting all the nutrition he needs, which is absolutely essential for him to get better.

 

[goholistic]

Okay, I will try spooning it in next time. I should be able to get more into him.

Does anyone have experience with B12 injections for this condition? I can't imagine it would hurt him and was going to ask my vet about it. I thought maybe it would help with Sebastian's energy and increase his appetite. Right now he's sleeping, but he looks very comfortable, and I thought I heard a snore.

 

[vball91]

B12 injections have been helpful for gentle appetite stimulation and some other general well-being reasons, so definitely do discuss with your vet. Good idea definitely!

 

[goholistic]

Okay, same thing tonight. Sebastian actually broke out into a little run towards the kitchen for dinner. Followed me around like he was starving, but didn't want anything I put down for him (three dry foods and three wet foods). He took a couple nibbles of the Kitten Chow, which is the only thing he'll touch right now. I know its a horrible food, but I've been told something is better than nothing. So, assist feeding again. I did not water it down and was able to give him about 1/4 can in two syringes, but I think it was too much at once. He started stressing after the first syringe and trying to tell me he is done, even with my encouraging voice, gentle pets and kisses.

I'm really hoping the Cerenia helps if I'm able to get that from my vet. How long must I keep this up? How long does nausea last for cats with pancreatitis? My family thinks it's torture to syringe feed him for very long, and that if he doesn't want to eat, it's for a reason. Do they think I'm just going to let him starve and get hepatic lipidosis?

 

[maewkaew]

Oh I hate that when the poor cat wants to eat , but then feels too nauseated and turns away.  It is heartbreaking.   and scary.    Poor Sebastian.  give him a little hug. 

The Cerenia helped Louis a  LOT.   So did famotidine ( Pepcid AC)  which was always part of my arsenal in a p-itis attack. 

 .   I  don't think  I ever had to syringe feed more than about 2 - 3 days.   If it had kept going on , I absolutely would have had a temp feeding tube put in.   but not sure which kind.  I think my vet said they didn't really like the nasal kind.    

I have added a small amount of water ,  both because it just seems to make it go a bit smoother through the syringe,  and also because I want to make sure he gets enough water.     

but it's not required. 

 I like syringes at least 10 ml  size and with the larger size opening.    ( But even with that, IMO  it is still quicker to stuff the food in through the top.) 

Probably is a good idea to do the syringe feeding in a different room.  because i think part of it can become psychological.   

 Here is an article from a vet's site about feeding tubes  http://www.catinfo.org/?link=feedingtubes          

    

Louis  would  like to send some vibes  

to Sebastian.    

 

[goholistic]

I know. I get that sick feeling in my stomach every time he walks away from his food. I give him the opportunity to eat on his own first. If it's a no-go, then I'll syringe feed.

We had a little bit of a breakthrough this morning. He came downstairs for breakfast like he was hungry. He ate some wet food and a little dry on his own. It was enough, so I gave him a break from the syringe feeding. He hasn't wanted wet food at all for like a week (probably due to the nausea?). The three dry foods I've been putting out are Blue Freedom, Merrick Purrfect Bistro Adult Salmon, and Kitten Chow. This morning he choose the Blue and Merrick, so I picked up the Kitten Chow. He was previously on a small amount of Nature's Variety Limited Ingredient Duck to accompany his variety of wet foods, but he stopped eating the Nature's Variety and I thought maybe the clay that they put in that food might be too harsh for his system.

So, I started to think about the whole timeline thing. I know we don't really know what causes pancreatitis, but my gut is telling me that this has something to do with the physical and emotional stress of his dental work. Perhaps a reaction from the anesthesia? Or the antibiotic injection they gave him after the sutures had prematurely come out where his upper canine tooth was removed? I plan to ask what antibiotic they gave then. It might have been different than the Covenia and Flagyl they gave for the pancreatitis. He started to become a picky eater before the dental, so I assumed it was because of bad teeth. I hate not knowing.
 

 

[goholistic]

To make matters worse, I am now reading all the controversy on the Convenia antibiotic, and I believe Sebastian received that injection the first day he was hospitalized for pancreatitis. Ugh...the last thing I need is something else to make me worry.

I appreciate the good vibes.
 

 

[maewkaew]

 I'm  glad to hear he ate some on his own!  

You know,  it is hard to say what caused this to happen with his pancreas,   but stress sure can play a role.  

 

[maewkaew]

I forgot to mention that I also used B-12 injections.  

 

[goholistic]

I'm getting antsy. The husband/wife team that have been overseeing Sebastian's care were not in the office yesterday nor today. He's doing just okay, but still not himself. He eats a little on his own, but I supplement with syringe feeding and reward him afterwards with brushing (he LOVES to be brushed).

Another doc at the vet hospital called me back yesterday and wanted me to give him the Mirtazapine and Pepcid, but I said I didn't want to give him the Mirtazapine if the problem was actually nausea. I explained that he acts hungry and that he wants to eat, but then doesn't. She said it would help with the nausea. Does it, in fact, help with nausea? I decided against it until I can talk to the regular doc about Cerenia. I gave him a 1/4 tab of Pepcid, but it didn't seem to have much effect other than he was a little stressed from the pilling.

I think he would benefit greatly from sub-q fluids a few times a week, but I get the feeling that my vet doesn't "prescribe" that for doing at home. How do you all do sub-q fluids at home? Do you get supplies from your vet?

Also, I have been reading a little about diet and pancreatitis. I read that it is helpful for dogs with pancreatitis to be on a high protein, low fat diet. Apparently fats can aggravate the pancreas. There are differing opinions whether this is true for cats. If it was true for cats, then the A/D probably isn't the best wet food for him since it is high in fat. I want to do what's best for him. It is VERY difficult to find a wet food he likes that is 1) grain-free, 2) high-protein, 3) low-fat, and 4) without carrageenan. Which of those four criteria do you think would be most beneficial?