# Pancreatitis along with kidney diseased/CRF cat (need advice)



## Paisley77 (Jul 27, 2012)

Well, Bitsy has been diagnosed with pancreatitis and that's probably why she's been so sick this week. Here's my post regarding what's going on - http://www.catforum.com/forum/38-health-nutrition/157970-kidney-failure-how-know-last-stages.html

She had the SPEC fPL pancreas test done and it's suppose to be below 3.5 and her value was *44.0*. So it's very high. Her other blood values are listed in the link above. She had more blood drawn today and I'll know in the next day or two how her values have changed since being on IV, nausea & antibiotic for the past 24 hrs.

I was wondering if anyone else has experienced pancreatitis with a kitty who suffers from kidney disease? And was wondering what things worked and what didn't? Would you have any diet recommendations?

I worry that the high protein wet diet that I put her on a few weeks back may have contributed to this, but not sure whether I'll ever know. Her WBC counts have been elevated slightly since May, but it was alot higher this week.

My vet hasn't given much advice yet, but I haven't picked her up yet and they may want to discuss that later with me (plus my two vets are out of the office today and tomorrow and there's a sub).

I appreciate any help - I've been searching out here for other posts on pancreatitis and only found a couple regarding this and was hoping for more insight. Thanks!


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## Brenda (Aug 29, 2012)

My 6 month old kitten, Smokey, suddenly got sick, was lethargic, not eating, and threw up a huge pile of bile. I took him to the vet first thing in the morning and they treated him during the day with antibiotics and nausea meds, I took him home, but nothing changed, so the next morning I took him back to the vet again. By late afternoon he had not gotten any better, in fact was worse, so they kept him overnight. The next day they drew more blood and found that his sugar levels were very high and gave him large doses of insulin during the night to see if that would help any, however, his condition was just worsening. The vet really had no hope that he would get better, as he said there were two possible problems. Firstly, if he was diabetic, he could be treated, and survive, but if the insulin did not work then chances are he has pancreatitis, which is rather uncommon in a kitten. Needless to say I was devastated and very heartsore about the diagnosis, but still kept on hoping he would be better in the morning. I phoned the vet early and was told that he is worse the insulin did not help, and they don't think he would make the day, they recommend that he be euthanased. It was a terrible decision to make, but the vet euthanased him and then did an autopsy. He at first was shocked because he could not even find my kitten's pancreas, but after looking carefully he found a tiny blob which was the pancreas, his kidney's were also 80% non functioning. The vet said that there was no chance that he would have survived without his pancreas and he was very surprised that the kitten had lived so long. He could only put it down to being a genetic defect. I hope that this helps you in any way, I also googled every possible option but found that pancreatitus is more common in older cats and in dogs, and that it is treatable if detected early. My kitten unfortunately could not be treated. I really hope in my heart that you find a cure for your kitten, as I was totally traumatised by this whole episode and very heart broken, and would not wish this on anyone.


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## westfayetteville (Sep 22, 2011)

Hi Paisley77
I don't know much about Pancreatitis, but another site I'm on has some info, I will copy and paste It's a Diabetic cat care site
I hope this helps Bitsy


Pancreatitis 101​Below is information to help caregivers to understand what pancreatitis is and what seems to work best as far as treating this condition. Hopefully this will provide some information to discuss with your vet to confirm a diagnosis. Even more so, it is hoped that this information will give you some steps to take to try to avoid pancreatitis altogether. 

Dr. Hodgkins states in her book Your Cat, Secrets to a Longer, Stronger Life, cats with FD typically have at least low-grade pancreatitis as well. As a result, when a cat comes along that is not achieving expected results with insulin, initial thoughts should turn to the likelihood of pancreatitis. It is a very common disease, far more than has been believed in the past. According to Idexx Labs, pancreatitis is suspected to be one of the main causes of poor control in FD cats. To date, studies have only been completed at autopsy, however it is claimed at autopsy, 45% of felines without FD have some grade of pancreatitis. 

A CBC (complete blood count) cannot conclusively confirm pancreatitis, nor can it be conclusively confirmed by ultrasound, or by a physical exam. If the results of the CBC show elevated cholesterol and liver values in a cat, and/or an ultrasound shows inflammation or “spots” in the area, and/or a physical exam indicates some swelling or tenderness in the abdomen, it is a wise decision to ask for a pancreatitis test. Most low carb, wet fed cats will have a somewhat elevated cholesterol level, and most vets, knowing the cat is all wet fed, are not usually concerned by elevated cholesterol levels in cats due to the higher fat content in food. That said, very high cholesterol levels can lead to pancreatitis and sometimes lead to other issues such as gallstones. 

If your cat is not responding to insulin, even when increasing doses, the test for pancreatitis would be a worthwhile spend to confirm or deny diagnosis. The only reliable test available at this time to measure serum feline pancreatic lipase immuno-reactivity level is the Spec fPL1 test by Idexx (see the side bar for more information). The test normally costs under $50.00 depending where you live. 
Because this test is relatively new, and because this disease is not yet well understood by most vets (who still believe that CBC, US and/or physical exam are sufficient for a diagnosis), if your cat isn’t responding to insulin as expected, liver and/or cholesterol levels are high end normal or above, and pancreatitis is remotely suspected, standing firm with your vet may be called for to get the test if you want a conclusive diagnosis. 

*What is Pancreatitis?

*The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help our cats digest fats, proteins and carbs in food. The pancreas also releases insulin and glucagon into the blood – these hormones help the body use the glucose it takes from food for energy. Typically, digestive enzymes don’t become active until they land in the small intestine when digestion of food starts. But, when these enzymes become active inside the pancreas or at the duct area, they can start to “digest” the pancreas/duct, causing inflammation and even permanent damage.

There are two main forms of pancreatitis - Acute pancreatitis and Chronic pancreatitis. 

The low level form of pancreatitis Dr. H refers to in her book is typically of the chronic kind. It hides itself well, lurking below the surface, doing its damage undetected. Chronic pancreatitis is no less dangerous than Acute pancreatitis if left untreated over the long term. It is generally believed that chronic pancreatitis does not ever resolve. Recent studies indicate that supplementation of taurine and sylmarin aid in the regeneration of both the liver and the pancreas. With long-term supplementation, pancreatitis usually can be well managed depending on the severity and how quickly it is caught.

Because cats hide pain so well, the signs that our cats aren’t feeling well are usually so subtle they are missed by even the most attentive of owners. Something as subtle as your cat repeatedly seeking out cool places to rest their tummies could be a clue that chronic pancreatitis is brewing in the background, as pancreatitis can cause abdominal pain. In humans, the pain is described as being “similar” to extreme heartburn, sometimes coming and going. The pain may get worse when eating or drinking, and can become consistent and disabling. In certain cases, abdominal pain actually goes away as the disease progresses, likely because the pancreas stops making digestive enzymes. Other common signs of pancreatitis are vomiting, nausea, weight loss (even if eating habits are normal), fatty stools, and lethargy. 

Acute pancreatitis - as its name portrays, the “attack” (and it is always an attack) is acute – coming on very suddenly and severely. A cat that was “fine” at lunch, eating – playing – alert…could become a limp-anorexic-unresponsive kitty by dinnertime. In the event of an acute pancreatitis attack, it is imperative to respond immediately to the crisis. Aggressive insulin treatment if needed, syringe feeding (or insertion of a feeding tube), subcutaneous fluid administration, and pain management are called for right away. An acute pancreatitis attack can take anywhere from one to two weeks (or longer) to resolve to the point where a cat is able to eat on its own. If immediate action is not taken, acute pancreatitis attacks can be fatal.

Both forms of pancreatitis can cause serious complications for our cats…. some more severe than others. Malabsorption of food, internal bleeding, damage to tissue, infection, cysts, fluid accumulation, enzymes and toxins entering the bloodstream, damage to the heart, lungs, kidneys, and/or other organs may occur if left untreated. It is suspected that pancreatitis in cats may also cause FD. Diabetes develops because insulin-producing cells (the islet cells) of the pancreas become damaged.

For more information, here is a link to Idexx’s  Roundtable on Pancreatitis.

*What causes pancreatitis?

*In humans, pancreatitis is caused by alcohol abuse, the pancreatic duct becoming blocked or narrowed; high levels of calcium, high levels of blood fats, autoimmune conditions, and some drugs to mention a few causes. It can also be idiopathic (unknown cause), or hereditary. Other than alcohol abuse, it makes sense that any of the things that cause pancreatitis in humans can cause it in our feline friends.

*So what to do?*
Traditional vet therapies for pancreatitis include the withholding of food for 24-48 hours. This has been standard practice when treating small dogs, but this is not the right way to go for cats. Particularly with cats on insulin, they need their food to keep their strength up. An all wet diet, low in fiber, and as low in fat as possible is better indicated to help ease the load on the pancreas. 

If your cat is anorexic and syringe feeding is not possible, a feeding tube (inserted by the vet) is highly recommended. In the TR College of Knowledge, there is a recipe for the Sick Mix, which is recommended when the need for syringe feeding arises. Supplements (other than Slippery Elm) can be mixed into the Sick Mix formula.

Any owner of an FD cat would be well advised to start their cat on a supplementation program right after FD diagnosis to try to avoid the development of pancreatitis altogether.

*Supplements

*As previously mentioned, supplements are proving to have a strong place when it comes to pancreatitis. The standard rule of thumb for dosage when it comes to cat is 1/6th (for larger cats) to 1/10th (for smaller cats) of a human dose. It is always a good idea to start out with a lower than recommended dose and work your way up to a suitable amount for your cat. Some supplements have a very strong taste or smell and are not always well accepted at first. In addition, it is best to start supplementation one supplement at a time. There is no way to know how your individual cat will accept the individual supplements, or how they will affect their BG. By taking it slow but steady, if there are any challenges with any supplement, you will have a much better idea of which one might be causing any problems for your cat.

*Sylmarin* is a wonderful liver support, also recommended for FD cats by Dr. H in her book. Recent studies have shown that sylmarin works to regenerate liver cells. SamE is also excellent support for both liver and pancreas. Denemarin or Sam-E 100 both contain both Sam-E and Sylmarin. Denosyl is plain Sam-E, while Milk Thistle Tincture is just sylmarin. There is also plain Sam-E for humans on the market, but the tablets are usually too large for cats. SamE has an enteric coatiing and must be given on an empty stomach. 

Denemarin and Denosyl are both vet products that come as enteric coated tablets which cannot be broken. They must dissolve in the gut and therefore must be given on an empty stomach.

Milk thistle – the active ingredient in milk thistle is sylmarin. It comes in powder and liquid form. The challenge with powder forms is that rice flour and other carbs not suitable for FD cats are usually added. If possible, liquid milk thistle (tincture) is a better choice. Look for the highest amounts of sylmarin extract you can find (70% or more), and the lowest count of ethanol (alcohol) – ideally under 5%. 

Choose only one of the above mentioned supplements, not all of them. Milk Thistle (sylmarin) can be given along with Denemarin. 

*Taurine* – preliminary recent studies indicate that taurine is also capable of regenerating cells of the liver, as well as pancreatic cells. This is exciting news! The maximum dose of taurine is up to 500mg per day. 

*L-carnitine* – this amino acid helps the system break down fats to process them through the system. Acytel Carnitine or D-carnitine are NOT at all suitable for cats. You will want to make sure you get the purest form of L-Carnitine you can find. Nature’s Way has a suitable L-Carnitine product for cats, available through Vitacost at a very reasonable price. Daily dose 250mg. Here’s a great article on the benefits of LCarnitine, follow the links to “learn more”…the sidebars have great info on the use of LCarnitine in cats as well. 

In humans, the use of L Carnitine is not recommended for those who have seizures, are using blood thinners, or have hypothyroidism. Similar caution for use in cats is recommended.

*Agaricus Blazeii mushrooms* – available in capsule form, and also available in liquid form (called Super Bio liquid from Atlas World). Dr. H highly recommends all FD cats get this supplement. It is an overall immune system support. In fact, her instructions to me were “give your cat a quarter capsule a day and take the rest yourself”.

*Acidophilus* – this probiotic is very helpful when it comes to malabsorption issues, which are very common for cats with pancreatitis. Daily recommended dose is ¼ capsule a day. Make sure that there are no sugars or FOS in any probiotic you choose. While the argument is that FOS does not cause resistant BG or other health issues in humans, experience on forum so far indicates FOS does cause problems for our cats. Country Life makes a dairy free version with no sugars, suitable for FD cats.

*Slippery Elm Bark Powder* – is very helpful when it comes to malabsorption issues. The standard dose is 1/8 to ¼ tsp once a day. This supplement must not be given with any other supplements or medications as it renders them useless. It is best to give Slippery Elm two hours apart from any other supplementation/medication.

*Vitamin B-Complex* – this supplement is beneficial in times of stress. In the event of an attack of acute pancreatitis, add this supplement to food when syringe feeding. Look for B Complex which has a low amount of inositol and a good amount of folic acid. 

*Pancreatic enzymes* are also useful when dealing with pancreatitis. Speak to your vet before adding pancreatic enzymes to your supplement regime to deal with pancreatitis. Typically pancreatic enzymes are used when there are accompanying gastro-intestinal troubles. Pancreatic enzymes come in two forms - vegetable matter or animal matter. For obvious reasons, pancreatic enzymes made from animal matter are better for felines. Source Natural Pancreatic enzymes is an acceptable brand for FD kitties. 

*Other steps to take….

*Adding fluids, either subcutaneous fluids with electrolytes, or adding water or plain broth (directly to food or by syringe) is helpful. Dehydration is very common when dealing with pancreatitis, especially the acute form. Home made chicken broth, cooled with the fat skimmed off is usually better received than plain water and can be added to food or syringe fed with a baby dropper.

Pepcid AC (must be AC - active ingredient famotadine) is also very helpful when dealing with a cat with pancreatitis. Ideally given 20-30 minutes before feeding, the dose is 1/4 tablet twice a day (BID).

For pain management, ¼ of a baby aspirin only can be given for a day or two. Aspirin can be toxic in cats, so this is definitely not a suitable pain management therapy on an ongoing basis. *PLEASE CONSULT YOUR VET BEFORE GIVING ASPIRIN TO YOUR CAT!*

The treatment methods are the same for both Chronic and Acute pancreatitis – and the supplements are beneficial even if your cat doesn’t have pancreatitis as FD affects many organs. In fact, considering that recent studies prove even cats without FD contract pancreatitis, a reduced regime of supplementation as a preventative may be a good thing for your cats that are not diabetic. For further (more in depth) assistance please post on Talking TR forum.




© Diabetic Cat Care - Updated March 2012*
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