Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

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stoorworm
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Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by stoorworm »

Hello, everybody.
Wish all you and your feline friends are happy and healthy.

My 4yo male kitty has been in an out of the vet since December last year.
He had a nasty bout of UTI which flared up again in January and just when I thought he was doing alright after getting his antibiotics he started acting strange again, around the end of February.
He would go to a room he usually didn’t visit that much and lie on the carpet in loaf position. He also started slightly grazing on dry food instead of his usual hoover-like enthusiasm. Wet food was ok, though.
Just, minor changes in his behavior. Lack of 3am zoomies etc.
Got worried and took him to the vet but his bloodwork came out clean. They thought he might be depressed so I got some stress relieving meds and was advised to switch to the i/d comfort diet.

A day or two later he completely stopped eating so I hauled him back to the vet ASAP.
Long story short, clean bloodwork but they did some additional tests. His SAA infection levels were 118.6 and they found his pancreas was swollen via ultrasound. He was diagnosed with pancreatitis, got the camel lump fluids, was given pain and some anti nausea meds and scheduled for the next week for a check up.

Another week went by and although he was still not his usual self and only eating bit by bit his SAA results came in at 104.7 which is a slight decrease but still extremely high. He got scheduled for biweekly camel lump IV’s but after a couple of days I noticed he grew a lump on his lower left abdomen and had some fluid retention in his primordial pouch.

Another emergency vet haul.

This time around his SAA levels were down to the 71.3 but he was diagnosed with peritonitis and swollen abdominal lymph nodes. He was given general antibiotics and they also started him on prednisolone.
He had his general antibiotics shot on the 22nd and started prednisolone on the 24th of March.

He has been gradually improving and has gained his monstrous appetite back. The lump on the left side of his abdomen went down around the 24th or 25th so I’m assuming either the antibiotics or prednisolone worked.

After getting on prednisolone he’s been gradually improving.
Still isn’t that enthusiastic about i/d wet food but he’s been eating other wet foods like his usual self and even started stealing his sister’s food after finishing his own. Like he used to do. He tended to loaf up in pain and breathe fast after eating but it seems to be getting better each day.
Just today he started sleeping in pretzel position and stretching his belly etc. even without opioid pain meds. I counted his breathing rate and it seemed to be in the normal 20-40 per minute bracket.
He’s not completely recovered by any means but he’s improving.

Sorry for the unnecessarily long interlude. I’m worried out of my mind and I was venting.

My main worry is that this is taking a hell of a lot longer than acute pancreatitis to clear up. Granted, I got my 7-14 days info from the web but...
It has been around a month since he’s been feeling unwell and even though we just started antibiotics and steroids last week and they seem to be working I’m really worried if they’re just masking another problem like FIP or it was just a severe infection and he needed med support to battle it.

Has anyone else gone through a similar ordeal?
Any wise words or something me or the vets could be missing?
He’s improving but I’m still worried out of my mind, reading medical journals and spiraling out of control by the more sinister possibilities.

By the way, I’m in Japan so there’s also the Western vs Asian veterinary practices difference thing going on here.

Apologies for the long vent.
Best wishes to everyone!
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fjm
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by fjm »

I am glad he is improving, and that your vets seem to be on the ball. I don't have any specific experience but I think it is important to remember that "typical" recovery times are based on averages and norms - there will always be outliers who recover faster or more slowly. As long as he is improving steadily I would focus on that, and talk to your vets about when to start to fade out the steroids, and what would be the best diet to avoid a recurrence. I hope all goes well, and he is soon back to 3am zoomies!
stoorworm
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by stoorworm »

Hi everyone, thought I’d make an update.

We’re back from the vet and Potato seems to be improving.
The abdominal fluid build up has cleared but his pancreas is still inflamed and there’s still a vague lump at the lower left side of his abdomen. It’s right where the duodenum and the pancreas meet so I’m assuming it’s the inflammation. It’s gone down in size and lost it’s hardness though.

He’s been acting somewhat normal since we came back. Sleeping on the couch and bed as opposed to the floor, sleeping curled up etc.
He still has bouts of getting up and changing positions and he occasionally seems to be a little uncomfortable but he’s more relaxed than not.
He had been eating normally until dinner but then I tried to feed him royal canin sensitivity diet and he just played around with it a bit and left it.
Will try feeding him the whiskas wet food, he seems to like it better.
His stool was a little smooth and soft but it held it’s shape so not diarrhea level. I did feed him a different cat food this morning so that might be the reason.

He got another general antibiotics shot and 14 more days on prednisolone with the dose halved. If all goes well they’ll be tapering him off.
Will be back to the vet again on the 15th if his condition doesn’t deteriorate.

I really hope the treatment sticks.
His poor condition has been going on for more than a month and he’s been on antibiotics and steroids for around 10 days. His condition seems to be improving each day but I’m a worrywort and the moment something seems off I start thinking of the worst.
In hindsight, should have kept a diary to keep myself objective.
Actually, will start right now.
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by Mollycat »

Cautious optimism, perhaps.

A diary is crucial for these kind of situations and can be so helpful to the vet as well as keeping your observations as objective as possible. Decide on a poo chart to use for both colour and consistency, if you use clumping litter you can also measure or weigh the pee clumps, you can also put in food, any treats, any possible stresses like strangers coming to the house or a dog outside barking or anything like that, as stress-aggravated illnesses can generate noticeable changes in poop. With Molly my vet looked at my printed diary and charts and offered the wise verdict that there was no pattern whatsoever, but at least we could be sure of that.
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by fjm »

Very good news - if he is eating without pain or diarrhoea and that continues now that you have reduced the pred I think cautious optimism is definitely in order.

With four ageing animals I try to jot notes in my online calendar at the first sign of trouble, then keep a diary or spreadsheet if it continues. It can really help, not least to cut back on anxiety and to have something to hand to the vet if necessary (we are in lockdown here in the UK and at least half the people in the vets' car park these days seem to be on the phone to the reception staff with lists of things they meant to mention but forgot when their animal was collected from the car!).

I would try mixing a very little of the sensitivity diet with the Whiskas - just enough that he still eats it - and gradually increasing the proportion until he is eating mostly sensitivity. Once he is over this bout you want to take care to avoid another, and diet can be important for that. Welcome to the merry-go-round of finding a food that is both good for them and palatable to them!
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by stoorworm »

Thank you guys for the sound advice.
Jotted down what I remember of the last month already, the last couple of days being the most detailed.

I gave him some whiskas after the royal canin, he ate a bit and left the rest but I might have fed him a bit too much today so that might be the culprit. He has eaten in the morning and twice more before dinner. Around 60-70% of the wet food pack each meal. I was told to feed him in lesser portions 4-6 times a day. He cleared them all up. Only dinner was a bit iffy but I also tried to feed him a different brand first so there’s that too.
He seemed a little irritated and loafed up after dinner but relaxed and stretched out in 10-15 minutes.

Weirdly enough whiskas seems to be the least irritating one for him.
He seems to react negatively to hills and royal canin compared to whiskas.
He tends to clean up a bit and then lie down, relaxed after eating whiskas but when I try to make him eat the medical wet foods he has that pain loaf posture right after eating.
I know whiskas is probably nutritionally lacking compared to them but I think I see a pattern here.
He was on the I/d wet food diet right around when he started feeling unwell.

Huh.
Journaling is awesome.
It might just be a coincidence but I’ll feed him with whiskas alone for a while and see how it goes.
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by Mollycat »

You're concerned about Whiskas not being the best nutritionally but if it's the one that keeps his GI health issues under control then that's a strong case for it being the best for him. No food on earth is any good if they won't eat it or it comes out prematurely or incompletely digested, both vomiting and diarrhoea mean some nutrients have not got into his system. Besides, they do have to meet certain minimum requirements that might not keep a cat in the best possible health but will give it the basics it needs. Don't beat yourself up, go with what works. Only thing is the nature of these kind of intermittent issues with flares, there isn't always a linear connection and sometimes it will flare for absolutely no figurable reason - ask any human with food intolerances or something like Crohns, IBS, ulcerative colitis or a thousand and one other of these conditions. You can do everything perfectly and still get a flare, or do everything wrong and get away with it for weeks.


On another forum I used to be on years ago, someone had been advised to feed their cat prime chicken breast, mashed potato and condensed milk, ostensibly because it was a pedigree. It wasn't long before the cat became ill. Whiskas is immeasurably better than that. Don't worry.
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by fjm »

Absolutely go with what works! If he is refusing the sensitivity because it makes him feel ill that is very different from refusing it because the taste and texture are unfamiliar.
stoorworm
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please.

Post by stoorworm »

Hello everyone!
Thought I’d give another update for those who might be going through a similar ordeal.

I’ve been trying to find a better alternative to whiskas wet food to fit his needs (history of UTI and current pancreatitis which developed into peritonitis) and I think I’ve finally hit jackpot!
Not that whiskas isn’t awesome, but it doesn’t seem to be helping him along with his condition.

None of the vet recommended diets were deemed edible by his royal highness. Hills, Royal Canin, Purina etc. were all snubbed off. He only had eyes for Whiskas wet food. I’m also suspecting some of the vet recommended diets aggravated his condition because he seemed to be in more pain after eating those compared to after eating whiskas pouches.
I’d came across many articles about novel protein diets on the net and seeing that his pancreatitis probably stems from a GI issue wanted to give it a go.
I’ve been continuously visiting the local pet shop and buying one of every food item that might be beneficial to him for the last month and trying and failing to find a product that suits him and that he’s interested in. I’m pretty sure they’ve pegged me as a weirdo by now. Last time during checkout the clerk asked me if I was aware the cat food I was purchasing was meant for GI problems, lol.

In comes Ziwi.
Gave it a go today and he absolutely devoured it. Air dried lamb, wheat and additive free.
He hasn’t been in pain after eating either. Which is really out of the norm. He is on top of the fridge right now, he hasn’t even tried to scale it in the last month or so.
I want to try the wet version because he needs his fluids but I’ll have to order online for that.
Hope it’s not a fluke, fingers crossed.

Also, his swollen lymph nodes and peritonitis seem to have receded. Probably thanks to the antibiotics and steroids. Only the pancreas is still inflamed.

On an unrelated note:
I took a picture of his highness today and thanks to the angle noticed that his left iris reflects red while his right iris was the normal greenish colour. Red irises are due to the lack of tapetum lucidum, just like us humans.

Per usual, I panicked. I mean, who wouldn’t? (Yes, you probably wouldn’t but I’m already on edge here and paranoid about FIP which shows up as ocular problems too so bare with me.)

Checked his previous photos from years ago and lo and behold he had green reflection in both irises in 2018.
Panicked again, phoned the vet but it was after hours so I asked the poor bloke on the other end for the list of medications Potato had been administered and scoured online databases for articles regarding tapetum degeneration and the history of his treatments.
For naught.
Found another photo from Jan 2020. He had two different coloured irises back then too. The deterioration of the tapetum seems to have happened between 2018 and 2020. Probably because he’s a white cat.

Oh, also thank you guys again for advising me to monitor him daily and keep tally.
Decided to take daily photos of his droppings for reference and I discovered something that looks extremely similar to a tapeworm! Couldn’t see it with solely my eyes but it was visible when I zoomed in on the photo!
stoorworm
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Re: Pancreatitis triggered peritonitis, worried about FIP. Anyone experienced? Advice, please?

Post by stoorworm »

Hello everyone.

I’m afraid I have some bad news.
There’s a 90% chance that it’s FIP.

He’s had severe pancreatitis and one bout of peritonitis with fluid buildup in the abdomen.
The peritonitis and fluid build up responded to steroids but his pancreatitis never showed any sign of improvement.

His TP count being high and his A/G ratio being so low I harassed the vets into doing a FCoV test and his coronavirus antibody titers were a whopping 6400.
Normal levels are 0-100.
Still waiting for other test results to be sure but time is of the essence so I scrambled to find the FIP medicine asap.
I’ve obtained the drug GS-441524 and we’ve started the grueling 84 day treatment.

He’s only on his second day of treatment and I don’t want to jinx it but his condition already seems to be improving!
He can sleep normally, breathing rate is almost back to normal and he doesn’t show signs of pain after eating.

His is a weird case of FIP but that blasted disease comes in many forms...
He’s 4 years old and quite a hefty chonker. Didn’t have much of a fever other than the occasional instance or two.
The infection seems to be contained mainly around his pancreas.
I think his immune system has been fighting it so well that it was hard to diagnose.

I’m **** at my old vet for ignoring me for months when I was insisting on a FCoV test.
Found a new place, a lot closer to home and they’re very supportive of the treatment too.
They’re even helping me with the daily injections until I can manage to do them in my own.
I’ll also have bloodwork done there once every two weeks.

I know it’s very pricy and a looong long process but please don’t give up if your kitty is diagnosed with FIP.
With the new medicines there’s a high recovery rate.
Hell, it’s a higher recovery rate than acute pancreatitis!
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