Pancreatitis is hard to diagnose and often seems to resolve by itself
no matter what you do. Our cat had the symptoms you describe (although
the vet did not do ultrasound) and on a hunch the vet sent out for a
pancreatic enzyme assay (called TLI). Unfortunately this kind of test
takes 3-4 weeks to get results and by the time the results did come
back, my cat had completely recovered. But the vet said the test did
show evidence of pancreatitis. I think this test is not certain either,
but the best test currently available. While our cat did show signs of
pain (hunching, walking very slowly) she was also not eating. Thinking
it might be some kind of infection the vet also prescribed an
antibiotic and he gave us an appetite stimulant. Once she started on
the antibiotic, it only took one dose of the appetite stimulant and she
started eating again. After that she began to recover.

I guess my point is that it's hard to be sure that a cat has
pancreatitis--the vet isn't even sure that our cat really had it
despite the assay. However, if your cat has been in pain from
pancreatitis for a month, I'd think I'd want the vet to see if anything
more can be done. It is a painful condition and I think sometimes vets
prescribe Fentanyl patches to control the pain. But it seems to me that
in a month it would have started to heal and become less painful.
-Yngver

Hi Teri, keep giving him torbutrol! Chronic feline pancreatitis outlook
is usually judged to be bad to fair. Opioids are really the least of
your problems.

While pancreatic inflammation can be visible via ultrasound the only
way to diagnose it is to do PLI/TLI blood test (the turn-around is
usually 7 days - the test needs to be sent to laboratory in Texas; my
cat's results came back in 5 days). TLI alone, especially in cats, is
not always indicative. PLI/TLI test IS conclusive. It is important to
do this test because lymphoma has exactly the same symptoms and also
presents as an inflammation on abdominal ultrasound (you'll need biopsy
or at least laparoscopy to fully diagnose lymphoma).

It's wrong to think that chronic pancreatitis resolves itself - it
does not. It's a chronic disease marked by returns of acute periods.
Once it presents itself, it always comes back. There is, at present, NO
treatment for it.

Sometimes, but not always, pancreatitis is caused by infection in the
GI track. The theory goes that bacteria backs down to pancreatic ducts
and causes inflammation. For that possibility vets usually prescribe a
short course of antibiotics. The antibiotics do nothing for
pancreatitis. Be resistant to prolonged use of antibiotics if there is
no improvement after first two weeks.  My cat's pancreatitis wasn't
caused by infection and I wasted a month giving him antibiotics.

Another thing, if he's not getting better maybe you should consider
steroids? My cat, for as long as he was only on painkiller and some
supportive medicine, did NOT improve. In fact, he got worse and I ended
up regretting I didn't give him steroids sooner (this disease took a
lot out of him, he's aged a lot). Budesonide (rather 'mild' steroid)
made him better in just few days. (Btw, it's important to exclude
lymphoma because steroids without chemo are not a good cancer
treatment.)

Other things you might want to consider before adding steroid therapy:
- Subcutaneous fluids (really easy to learn and very helpful)
- Vit. B12 injections (can be added via IV port during sub-q fluids)
- Vit. C injections (unless there is UTI or CRF present, administered
same way as B12)
- Vit. E
- Omega 3 (salmon oil)
- Denosyl (if liver enzymes are elevated as well)
- Pancreatic enzymes derived from animal pancreas not plants with every
meal (my cat hated it and I had to syringe him immediately after every
meal with a mixture of food, water and incubated enzymes - I thought
it was essential that his pancreas gets a rest).

If your cat is still eating consider yourself lucky but don't count on
it long term. Cats with pancreatitis get anorexic sooner rather than
later. The medical solutions are not very good (assisted feeding,
e-tube, appetite stimulants that make cats behave oddly). He should eat
often (every 3 hours even at night) and small amounts (empty stomach
and/or a lot of food at once tend to induce pain). Watch for symptoms
of pain and give him food in the intervals, when he's physically able
to eat. The attacks tend to wear off in 4-8 hours. Painkiller is your
friend. Watch how rested he is after an attack that was helped with
painkiller and how hard it is for him to bounce back when he didn't get
it. He needs strength to fight pancreatitis. (Btw, I'm not sure if
torbutrol comes in liquid version, buprenex, which is a similar drug
does. You squirt it into the cheek pouch, the results are immediate.
So you can actually wait until the attack starts and not give it on
regular basis.)

L. acidophilus (probotic) shows some potential in helping soft stools.
And try slippery elm bark powder, which should also help with some
discomfort, diarrhea/soft stools and nausea.

My cat had his last attack in January and was battling the more acute
version of the disease since September. And I'm not sure he's really
over it yet. Be prepared: this may be long term. And yes, he's worth
the trouble.

Good luck,

Alice

Hi Teri,

Sorry your cat is not feeling so well. Our cat, Bob, also had chronic
pancreatitus. I'll tell you some of his story to see if it helps.

His started six months after his diabetes diagnosis (which happened
right after a steroid shot for allergies...)

Bob would throw up, have diarrhea, a high fever and just be listless. He
was in pain and would yowl if we picked him up. During his first six
months after diagnosis, he probably had about three major attacks that
sent him to the hospital, some for a week at a time. He was always
treated by an internist vet, a specialist. He was on an IV and his fever
watched carefully. He usually had to be force fed. The internist said
anti-nausea drugs do not work with cats. The treatment was basically
supportive care to get him through the episode. They also always sent
him home with metronidizole (sp?).

The vet said once a cat has pancreatitus, it changes the lining inside
of the pancreas which is why it often becomes a chronic problem. She
also said that the way to treat it in dogs is to fast them and rest the
pancreas. Because of the way cats are built, they cannot be fasted
without possible liver damage -- so treating it gets more complicated.

At the end of that six months, we were frazzled and a few thousand
dollars shorter. At Christmas, we found Bob again in pain and we didn't
know what to do. My sig. other thought maybe it was time to let him go
because this was no way to live, but I told him I could not think of
letting Bob go yet. We took him to the hospital again, he got better and
voila! No more attacks for a year!

Bob had a wonderful, pain-free year, relaxing on his window. I told you
all of this because watching your cat go through such pain can be
harrowing, plus the expense and the vet trips -- but they can have long
periods of a wonderful life.

In case you're wondering, Bob died that next year of cancer. It was not
related to his pancreas problems.

Good luck with your cat,

Rhonda

The results on my cat's PLI have come back - 3.3.  WNL.  That would be
great if he were looking better.  To recap:  He has been showing what
to me looks like signs of abdominal pain.  He doesn't play or run
around the house,he sits around hunching down much of the time.  That
is his only symptom.  Other than that he is eating great, no vomiting,
occasional soft stool, no diarrhea, no weight loss.  Palpating his
abdomen seems ok, no crying or fighting with that.  He had an
abdominal ultrasound Feb. 1 that showed a very inflammed pancreas
which is where the diagnosis of pancreaitis came from, and a smaller
liver.  Liver studies have all been normal including bile acid
studies.  Dr.s concluded that is just normal for him.  He has been on
Torbutrol since Feb. 1 which does help him and make him look more
comfortable - plays, doesn't hunch down as much.  He still needs the
torb, but he is down to a quarter of a tablet BID which is down from a
half.   Just started on Metronidazole, thinking IBD could be causing
the abdominal pain signs.  He has been in Hill's ID since mid January.

Any other ideas on why he doesn't feel better despite a normal PLI?
Teri