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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 30310
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My cat is 12 years old, diagnosed with chronic pancreatitis.

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Hello, my cat is 12 years old, diagnosed with chronic pancreatitis. Hard to manage. Lately was lethargic and vomiting. I suggested the vet to resumed perdisolone (daly twice a day, for a week), which she took one and a half years ago with good results. I also suggested pancreatic enzimes (daily), which she has just started. The vet is injecting vitamin b12 once a week, together with subcutaneous hidration (once a week), celenia for nausea(once a week), pain medication (only once a week). Vet also recommended probiotics (daily) omeoprazole (dayly), and oral pain medicien (daily). I suspect that she has pancreatic insufficiency, as she shows all the signs: flatulence, strong fecal odour, soft, yellowish feces, etc.
I have two questions:
a) is her regime adequate? she seems a little better since predisolone, which she started two days ago, and maybe since taking enzymes once a day. But I have doubts, have read that probiotics may be damaging and perhaps her enzymes regime dosage is too low to be really effective.
b) i´ve been told that chronic pancreatitis is progresive and leading to death once her pancreas stops working. Is this really so? I´ve read a lot about chronic pancreatitis/pancreatic insufficieny and so far my sources suggest that the disease may be managed successfully.
I have become my cat advocate and researcher, as I feel that vetadvice in my country are often limited and not up tpo date.
Thank you and best regards.
My name is ***** ***** Mexico City.

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Customer: replied 1 month ago.
Thank you very much, Dr. Salkin.
Customer: replied 1 month ago.
Forgot to say, Puka is also having antibiotics injected once a week...

Olga, supportive care comprising of correction of fluid/electrolyte imbalances, pain management, and nutritional support are the mainstay of therapy for cats with pancreatitis. Dehydration, acid-base and electrolyte abnormalities should be corrected during the first 12-24 hours. Although abdominal pain is not commonly described in cats with pancreatitis, it's likely to be present in most cases and may contribute to anorexia. Pain medication once weekly may not suffice. Meperidine and buprenorphine are opioids to consider daily for Puka. Antiemetics such as the Cerenia should be administered to all cats that are vomiting. Once weekly administration of the Cerenia isn't standard of care but won't be harmful. In most cases, pancreatitis begins as a sterile process and so antibiotic therapy is controversial. Antibiotic considerations are possibly more important for acute pancreatitis than for treatment of chronic disease. Cats with demonstrated lymphocytic pancreatitis, with or without concurrent inflammatory bowel disease (IBD) or lymphocytic cholangitis, should be treated with glucocorticoids such as prednisolone. There is no justification for use of these drugs in cats with acute necrotizing or acute suppurative pancreatitis or cats for which the cause of pancreatitis hasn't been diagnosed histologically. Use of glucocorticoids creates a risk of iatrogenic diabetes mellitus. Proteolytic enzymes make sense in these cats. If veterinary products (Viokase, e.g.) are prescribed, there's little risk of under or overdosing the enzymes. Finally, antacids such as omeprazole and probiotics are reasonable although I must admit that we don't know the value of probiotics in these cats. Once again, they shouldn't be harmful, however. I'm such a devil's advocate...

Please respond with further questions or concerns if you wish.

Customer: replied 1 month ago.
Thank you for your response.
a) Puka´s pancreatitis has not been studied histologically. Do you think it is worth submitting her to a biopsy?
c) She has not vomited for the last two days, but she did vomit every other day and often daily before she last saw the vet on Tuesday, when she injected Celenia. Should I give her Celenia when she starts vomiting, or should I rather wait to see the vet (once a week).
d) Will the predisolone be harmful if given for only one week? when she had an acute episode it was highly effective, and this time it looks that predisolone is being having a good effect, but I am not 100% sure.
e) the vet did not seem too worried about Puka having an electrolyte imbalance when she last saw he, but Puka looks lethargic..Do you think she should be given preventive intravenous hydration?
f) there are not veterinarian pancreatic enzymes in Mexico, but she is taking 150 pancreatinine capsules for human use, which I have been opening and spreading in her food.
g) if her condition is chronic, will it progress -as I´ve been told- to the point of a horrible death? what is the prognosis in these cases?
h) should I try another vet, perhaps at a veterinary treatment center at the University, where they do research? LAst year I took her there when she had her acute episode. Medically, everything was excellent, except for the fact that the vet center is massive and extremely crowded, full of barking dogs, and every single time to wait many hour (3-4 hours) sitting at the waiting room, with the poor kitty really stressed out. I felt that it was not worth stressing her to that point if she has a chronic problem, and I am therefore taking her to a small feline hospital. However, I am afraid that her problem is acute and not being diagnosed. How can I know?
I knoe these are complex questions, I I will be grateful for your help!

a) not unless she's not doing well and we need to know more about her pancreas

c) I prefer not to medicate cats with any more drugs than are absolutely necessary. The stress of dosing a cat can exascerbate illnesses. I would see if vomiting recurs before giving more Cerenia.

d) That would be unlikely. The risk of diabetes is seen more with injectable than oral forms of glucocorticoids. I never argue with success and a week's worth of prednisolone should suffice in any event.

e) I would administer subcutaneous fluids/electrolytes to a lethargic patient. They could only help.

f) I'm not familiar with the human product but it should suffice in terms of potency.

g) She's being treated well..if perhaps harmlessly overtreated. I don't see the benefit of a veterinary teaching hospital for such a patient unless her condition worsens in spite of what's being done. If that were the case, the diagnostic of choice is an abdominal ultrasound which might not be available at the small feline hospital but would be at the larger facility.

Please continue our conversation if you wish.

Customer: replied 1 month ago.
Thank you again, Dr Salkin! Great answers. Two more left:
a) Shall I give her oral Celenia if she starts vomiting? how many vomits before I medicate? dosage?
b) Again, the prognosis. Is chronic pancreatitis progressive to the point of a horrible death? Or is it rather treatable, as I have read?
Customer: replied 1 month ago.
Finally:
c) subcutaneous fluids/electrolytes daily? why not intravenous?

Yes, two vomiting episodes within a 24 hour period should prompt the administration of maropitant (Cerenia) dosed at 1 mg/kg daily for up to 5 consecutive days. The prognosis for cats with pancreatitis is directly related to the severity of the disease. Mild disease without pancreatic and systemic complications carries a good prognosis. Severe disease with pancreatic necrosis, pancreatic or peripancreatic fluid accumulations or systemic complications such as acute kidney injury carries a poor to grave prognosis. Severity may be difficult to assess without advanced imaging and/or biopsy. Basic diagnostics in the form of blood and urine tests tells us about systemic complications. For a cat who doesn't need to be hospitalized, subcutaneous fluid administration is quick, easy, effective, and less stressful than intravenous administration.

Customer: replied 1 month ago.
Thank you. as for vomiting/Celenia, perfectly clear. Subcutaneous fluids, how often? she has had blood tests with good results, not urine, which I will ask for. She has also had ultrasound, and I will ask the vet to provide me with more specifications. I´ll come back to ask for your help as soon as I have that information. It may take a couple of day and I guess an ultrasound will not be enough. I you recommend, could take her to a magnetic resonance imaging center for pets...

As needed. If she's eating and drinking normally, she doesn't need supplemental fluids. If there's any question concerning her intake or behavior, one administration of 100 mL will tell you if it were of value. The response to fluids can be rapid and dramatic. No, an MRI is unlikely to be needed. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Customer: replied 1 month ago.
Thank you very much Dr. Michael. I will definitively come back to you when I have complete information on the ultrasound.
Best regards!

Thank you for your kind accept. I appreciate it. I'll watch for your next post.