Veterinary Medicine - November 2008 - (Page DM14)

Williams: That’s right. Twedt: For cats with chronic cholangitis and pancreatitis, it is also reasonable to treat them with corticosteroids. Steiner: It is important that practitioners don’t just give corticosteroids as a knee-jerk reaction. I only give corticosteroids while monitoring Spec fPL results. I want to have a Spec fPL result before I start therapy and 10 days later. If the cat is clinically improved and the Spec fPL decreases, I’ll certainly continue. If the cat is better but the Spec fPL doesn’t decrease, I reconsider. Similarly, if the Spec fPL decreases but the cat doesn’t feel better, I think twice about corticosteroid use. If the Spec fPL increases and the cat doesn’t feel better, I certainly stop corticosteroid use. Twedt: What regimen do you use? Steiner: I use anti-in ammatory doses of oral prednisolone twice a day for 10 days. Further therapy is dependent on clinical signs and the re-evaluation of the Spec fPL. Williams: When people started putting gastrostomy tubes in cats with pancreatitis and feeding them, a concern was that they would crash and burn, but they didn’t. They did better. I think it’s the same with corticosteroids. When we started giving them because we were certain the cat had IBD, we worried that the pancreatitis would are up. It didn’t. I don’t hear about corticosteroid use causing patients to fall apart. Twedt: Probably the biggest contraindication for corticosteroids would be concurrent diabetes in a cat. Steiner: We’ve put a few diabetic cats with chronic pancreatitis on corticosteroids and were happy with the result. However, you do have to be extremely cautious. Robertson: Dr. Richard Nelson at the UC-Davis School of Veterinary Medicine has put cats with pancreatitis and hard-to-regulate diabetes on a two-week tapering course of prednisone to get the pancreatic in ammation under control. During that time, you don’t worry about the diabetes that much. Then after the two weeks when the cat has been tapered off of the prednisone, you manage the diabetes. If the pancreatitis improves with prednisone therapy, the diabetes itself becomes easier to regulate. Robertson: Does mirtazapine have bene ts over cyproheptadine? Is it just that the dosing schedule is easier, or is it also more effective? Forman: It seems to work better and the cats only need to be pilled once every third day rather then twice daily. Twedt: I think it’s more effective, and it also has some antiemetic effects. Forman: I start with mirtazapine, but if it doesn’t work and the owner doesn’t want to gure out why the cat is not eating, I switch to cyproheptadine or place a feeding tube. Monitoring Robertson: For hospitalized cats with acute pancreatitis, how do you monitor these patients? Forman: A lot of cats with acute pancreatitis need to be monitored closely, especially when we put them on crystalloids and colloids. I monitor the body weight and respiratory rate closely to make sure that they are tolerating these uids, and I stay alert for complications of pancreatitis, such as pleural effusion and dyspnea. Twedt: Electrolyte and acid-base balance are also important to monitor in these cases. Forman: I will also monitor blood pressure and urine output, especially if the cat is markedly depressed. I agree with Dr. Twedt, monitoring electrolytes once to twice a day and a PCV to screen for progressive anemia is important. Making sure the patient is not becoming hyperglycemic, especially if IV nutrition is being used, is also important. How I tailor my therapy to the individual patient is often dependent on these results. Robertson: In dogs with acute pancreatitis, we monitor the Spec cPL™ during hospitalization. Would you similarly recommend monitoring the Spec fPL for a cat with acute pancreatitis? Steiner: Yes. For acute pancreatitis cases, I would run the Spec fPL every two to three days or so. Robertson: When you are managing cats with chronic pancreatitis, how do you monitor them? For example, we’ve discussed repeating a Spec fPL 10 to 14 days after initiation of glucocorticoids. What do you consider a signi cant decrease in Spec fPL? Steiner: I look for big decreases. In my own cat the Spec fPL went from a measurement of above 300 to 32 µg/L in three days. That’s a significant decrease. If the results are not much different, say it goes from 35 to 30 µg/L, then I would want to see at least three measurements to convince me that it’s dropping. Appetite stimulants Robertson: Do you use any other therapies to manage cats with pancreatitis? Forman: I use appetite stimulants. I’ve been using mirtazapine (Remeron®—Schering-Plough), although we have no studies to support this and it is off-label. One advantage is that you only need to medicate the cat every third day. 14

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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