Hi - thank you so much for the SubQ video. I'be been freaking out trying to get it and your video calmed me down a bit. My 7-year-old male cat Scamp was diagnosed with pancreatitis after a night of vomiting Aug 30 (he was not a throwuppy cat before) and treated with 2 days in hospital IV etc, then home with antibiotics, anti-nausea, antacids, then appetite stimulants. He seemed to finally get back to normal after 10 days home. Then they said he needed to be treated for kidney disease, because of high creatinine 6.8! So he is now on subQ and kidney diet. And blood pressure meds today. After this week, with four SubQ’s, he isn't drinking much water and almost no food. He has no other kidney signs, he is not vomiting and seems fairly happy, but sleeping a lot. I gave him some pepcid this morning and later some app stimulant, which worked well last time and he hadn't had it for two weeks. I am obsessing looking for every sign of illness, because he doesn't seem to have stabilized. Any words of wisdom?

For those who want to know a bit more to follow along with Scamp’s answer, see this video to know what SubQ’s are if you don’t know yet.

Both pancreatitis (a situation that effects the pancreas, causing vomiting, no appetite and other issues) and kidney problems (CKD) can be scary when they happen together. And happen together does it ever, with frequency.
Sometimes one problem caused the other. Sometimes just one of the two things that came up wrong on the bloodwork was really the cause of illness, and the other we just happened to reveal by doing the bloodwork (i.e. it was a subclinical issue - yes it was there, but not responsible for why your cat got sick). It can quickly get complicated for folks who just want to see their pets get better, eat, and not be in pain! And look at those eyes in the picture! Scamp! Who would not be totally worried, after going through all that, that something from the equation could be missing. Something stopping him from getting better.

So in this answer, lets talk about 5 factors or techniques one could do to help figure things out:

1. The weight scale. If you have a cat with pancreatitis, or CKD, the scale can be your best friend. For either condition, especially both, knowing their weight tells you what to do. Weight is dropping? You need to change their plan. They are telling us that they need something else or something done a different way. Weight cycles up and down slightly around the same number? You're doing ok. I use this one: http://www2.withings.com/us/en/products/babyat home. That was just given to me by my father when this was born:

you don’t need something that fancy with blutooth and all that. Just something that measures accurately to the body size of those two in the picture. Maybe something like this: http://www.amazon.com/Salter-Electronic-Baby-Toddler-Scale/dp/B00009KX5U Holding them in your arms, measuring on an adult scale, then subtracting your own wait won’t be accurate enough for a tool to help you to establish stability. Baby scale all the way!

2. Know the relationships: Kidney issues sometimes make the pancreas upset and get inflamed. All that acid production and gastritis from the kidneys have a way of making the pancreas say No mas. I'm always thinking - was there a kidney infection? If there was, and the kidney’s kicked off the pancreas, then maybe I can reverse everything by finding and treating this potential infection. Wouldn’t that be great? Infection isn’t always the issue that starts all of this off, but I always go looking for it. Specifically, I am looking for silent pyelonephritis. Why is it called “silent”? Because it’s what cats do. They defy google descriptions, and common diagnostic tests (I'm looking at you, urine culture and sensitivity which sometimes lie!), yet when you treat them for it, they get better. So all in all - hopefully when his kidneys stabilize, everything else stabilizes.

3. Food. Since Scamp was not a throwuppy cat before (I like that term BTW), then maybe this is less crucial for him, but let’s face it, food is always important even if it’s indirectly so. Some cat’s get pancreatitis from sensitivity (i.e. allergic gut reactions) or intolerances to something in their diet. So tweaking the food is pretty important. When you change the food, the pancreas might take two weeks to two months to finally settle down…even if you are feeding the diet you're cat really requires. You can test your cat’s blood (and monitor body) weight to see how they are doing with the new food. It would take 3 blog post's and a book to go over food. No. Scratch that. You are Scamp's person. You live with him every day. You know who's going to know best about what food works the best? Scamp. And you because you see the subtle things about him as he responds (or doesn't) to different diets. And your team can help lead you to what might work by monitoring what his body is doing with whatever his chosen diet is, on the inside. Use body weight as your initial guide. Are they dropping weight still? Then I have my eye on the diet like a hawk!

4. The silent ouch. The biggest missing ingredient for cat’s who have pancreatitis, get treatment for it, but still won’t eat? Pain. They won’t yowl. Their posture can be ok. They won’t do anything that looks what pain should look like, but then you treat for pain, and then they start mowing down the food! Not all cat’s require pain medication to eat when they have pancreatitis, but those cat’s who are listless with their appetite - I definitely give them the benefit of the doubt and treat them for it. Always. You don’t want NSAID’s like Metacam here (http://www.iwillhelpyourcat.com/videos/#/metacam-cats/). I commonly use buprenorphine for this purpose. Pain med’s alone won’t work? Then I'm trying them together with antacids. I'm sticking with the antacids daily until they stabilize and show no loss in body weight. None of those things will work? That’s why I'm putting together an e-book on how to get them to eat when they don’t want to eat!

5. Buy yourself time. It is sometimes comforting for people to know that they just got to try longer to get the success they are after. It can take weeks for months when you get a double whammy like pancreatitis plus CKD. But I do see them get better all the time when these conditions happen. The journey to getting there can be hard for people, especially if you have a cat who is scared and it’s difficult to medicate them. One of the goals of this website is to eventually help people specifically with that issue. If I want to know there is not something my fingers, bloowork or xrays can’t reach, and I just need more time, I will suggest an abdominal ultrasound be performed to ensure it’s tweaking and time that they require. Not twerking and time, but I would twerk if that’s what a cat asked for to get better…

Hope that helps,

Dr. K