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Pancreatitis In A Cat

by CIVTdvm - November 3, 2020 View Case Report

4 yr old, M,N Persian cross (rescue/stray cat) - my own cat
Constitution: Metal/Water - aloof, independent, vocal and playful but wary of loud noises and strangers and likes to hide
Cool seeking - loves to spend hours in backyard, even if rain and cold weather, sleeps in the shade

Problem:
pyelonephritis, pancreatitis, inflammatory bowel disease, ileus

ultrasound findings: Pancreatitis (chronic, subacute) + pyelonephritis with bilateral dilated renal pelvis + ileus (especially pyloric and duodenal)

IDEXX specialist was concerned about necrotic, suppurative pancreatitis so rec'd I do 4-6 wk course of fluoroquinolone (marbofloxacin)

Diet: Honest Kitchen Turkey-->Hypo/renal Royal Canin--> GI Rayne sensitivity

Medications:
marbofloxacin 12.5 mg PO SID x 28 days
Gabapentin/buprenorphine (recently)

Supplements:
Denosyl PO SID x 60 days
omega fatty acids SID long term
vitb12 injections
Probiotics (Probenz)

TCVM - (from today--Nov.3)
tonuge: pale pink/light lavender
pulse: superficial, strong but compressible, width relatively normal, possibly slippery

TCVM dx:
Dampness
Damp Heat
Spleen Qi deficiency (loves to eat grass, occ. vomits it up - rebellious ST Qi)
Qi stagnation
Lung Qi stagnation(not descending and invigorating Kidney Qi )
LU Qi deficiency (voice became weak while ill, much stronger now)
KI Qi deficiency
BL dampness (crystalluria)
Blood stagnation
Kidney Ying deficiency (cryptorchid - affecting Chong mai)
Blood deficiency - dry, brittle nails with very dry nail beds (chronic)
Episodes of cough/sneeze (historic) – LU Qi stagnation (not descending)

Timeline:
Sept 1-14 = clavaseptin + Wei Ling Tang
Sept 15-30 - no abx + Wei Ling Tang + San Ren Tang
Oct. 4-Nov.4 - marbofloxacin (Both herbs stopped mid-October - stools were more dry/hard/small and recent u/s findings showed worsening of pancreas)

Blood work
SDMA: 16--->8---->14
creatinine: 123--->70--->83
fPLI: 37.1---->38.8---->6.7
vitb12: <100--------> >1800
(folate was normal)

Urine:
both cultures = NEG
pH >9.0----> 8.0
crystalluria---->no more crystals
USG = 1.040

Questions:
1. What is the most ideal herb formula choice for acute pancreatitis in general? I feel like WLT caused too much blood flow to pancreas and reflected worsening of disease for Lionel - too much heat (perhaps because already hot patient who is historically cool-seeking?)
2. What is the most ideal herb selection now with things resolving well?
3. Seems responsive to antibiotics - so either there was an active infection or benefits from the cooling effect of antibiotics - what are your thoughts?
4. What is the most appropriate diet options for him - I want to give canned rabbit food but Rayne canned food on back order indefinitely. He was on Honest Kitchen Turkey but does not suit him well and also since Sp Qi deficiency, should be avoiding raw food even dehydrated, correct?

Thank you so much in advance!
Christiane

Yin deficiency - dry, small stools (chronic)

by naturevet

November 4, 2020

Hi there,

Since the renal and pancreatic issues are now stable, I'd be wondering about Yi Guan Jian. Pyelonephritis (if that is what was going on) is almost invariably a Kidney Yin deficiency. This diagnosis would fit the hot constitution and the stool dryness you were seeing in response to warming drying treatments like WLT.

Despite the apparent worsening on WLT, studies on pancreatitis suggest that supporting pancreatic blood flow through nitric oxide synthesis prevents recurrence. YGJ has that effect. It also supports renal blood flow, and lubricates the intestinal tract to prevent dryness. It might thus be a better fit for Lionel than WLT.

For acute pancreatitis, the opposite effect on nitric oxide and blood flow is needed, making formulas like Xiao Chai Hu Tang, Si Miao San and San Ren Tang more potentially beneficial.

If you try YGJ and it keeps him stable and he seems to do well on it, then a nourishing dense cooling food is apropos. Raw fits that bill, as does any homemade meat-based diet. Note that Stomach Yin deficiency can cause vomiting and be associated with tendencies to GI inflammation including even colitis.

Hopefully this answers your questions and is helpful

Steve

Yi Guan Jian

by CIVTdvm

November 4, 2020

Thank you so much for your quick reply Steve. I really appreciate it! Yes, this was very helpful. I will make a note for the acute pancreatitis recommendations for future. I have ordered some herbs from NPHC so will start Lionel on YGJ right away when I receive them. His weight has been stable the past month (initially lost weight 4.2kg-->3.95kg - yin deficiency - and then gained and is now staying at 4.45kg). Clinically he is doing very well (other than the dry stools) and his recheck u/s last week showed improvement (although I do not have the report yet) so I want to discontinue the zeniquin (tonight was day 28th dose) but some specialists say 4-6 wks for zeniquin. I feel he will be well supported on YGJ - what is your thought on the antibiotic? Thank you in advance!

by naturevet

November 4, 2020

I would suggest making one change at a time. Maybe continue until he has been on the YGJ a week without incident, and then removing the antibiotic. If it will be some time before you get the YGJ going, then I guess you can stop the antibiotic now and see what happens

S

by CIVTdvm

November 13, 2020

Hi Steve,
I just received the herbs so I started Lionel on the YGJ two days ago. I will update you on how he seems to be responding. I did want to update you on the ultrasound report I received:
Kidneys:
Both kidneys remained symmetrically affected and presented an increased cortical echogenicity and papillary thickening with mild dilatation often minor and major calyx and subtle pelvic dilatation. Also, they presented a moderate to severe overall increase in size measuring 3.6 and 3.8 cm in length (n= 3.5 cm) on the left and right side, respectively (previous measurements were 3.8 and 4.2 cm on 2020-10-03 on the left and right side). These findings are compatible with an improving, ascending
pyelitis/nephritis

Pancreas:
The right limb of the pancreas was well-defined, subtly irregular and faintly hypoechoic but in the absence of secondary, regional, inflammatory disease. These findings are supportive of your diagnosis of a low-grade, seemingly resolving, chronic pancreatitis.

Intestine:
The jejunum presented a faint degree of mucosal inflammation in the absence of thickening as the wall in toto was not thickened measuring 0.23 cm in a segment that was only 2 cm long and referring to presents of low-grade inflammatory disease

Mesenteric Lymph nodes: (were normal in the Sept. ultrasound)
Lymphadenopathy was seen as two jejunal lymph nodes were mildly enlarged measuring 0.35 and 0.4 cm. Also, three adjacent, small duodenal lymph nodes were similarly and modestly enlarged recording at 0.3 0.5 and 0.6 cm. This findings are compatible with a mild manifestation of reactive lymphadenopathy.

I was advised to continue Marbofloxacin for 30 more days. However, I was thinking of discontinuing after 15 more days (while the YGJ is on board) and Lionel is clinically doing well.

I also wanted your opinion on his asthma - very mild and infrequent coughing episodes - lasting 5-to-10 seconds or so (over the last two years) - non progressive and has never been on any medications for it. I have been trying to keep his environment free of any respiratory irritants. YGJ does not seem to have any effect for asthma, so wondering what I could or should pair it with as a preventative/maintenance. I initially thought asthma was a failure of LU Qi to descend or a KI Qi deficiency by my cats is quite young and this was going on previous to the pyelonephritis. Is Rehmannia 8 the best option for young cats with asthma? Is it worth putting my cat on this herb long term for asthma management or could it be not ideal because of his concurrent pancreatitis/IBD/ileus? Thank you in advance

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