Biggles B.

Biggles Bonin - Lincoln, Rhode Island
Male, Domestic Short Hair
Born in 1999
Diagnosed with pancreatitis – August 2011
Diagnosed with diabetes ketoacidosis – September 2011

First Entry: November 12, 2011
Biggles was born from a stray in our neighborhood. She was a sweet girl that deserved a better life but we did
our best to at least keep her fed. She had two litters; Biggles was born in the spring, 1999. His litter was of your
normal variety a few orange tabbies, a gray tabby and a few torties. Biggles has had a few health issues (upper
respiratory infection, lower urinary tract infection), but overall a healthy cat for most of his life.

Biggles has always been a bit picky, to say the least, about his food. He has never eaten wet cat food, we have
tried every brand and flavor we can find that looks like human food. But there is something about it that tips him
off that it made for cats. He liked Max cat food until they changed the formula and he immediately turned his
nose up at it. We were given a recommendation of Felidae which he showed interest immediately.

In August 2011, I noticed one morning that Biggles was hanging around the water dish. He seemed a bit down
(lethargic), and was not really interested in his food. He had vomited a few times in the last few days and I also
noticed lip smacking. I tried to give him some cheese, another of his vises, which he also showed no interest. We
called his vet and they had us bring him down. They gave him fluids and took x-rays and did blood work. They
diagnosed him with severe pancreatitis. At this time, he weighed 12 lbs 6 oz. There was severe inflammation
around the pancreas. They recommended that we bring him to the veterinary specialist center in our area for
additional testing (ultrasound), and extended fluid therapy since he was severely dehydrated.

Ocean State did an initial physical exam in which they pushed on his stomach. Biggles growled which showed
that he was painful. They also detected a galloping heart beat which slowed the fluid treatments (heart failure
was a concern due to the heart condition with an aggressive treatment). The ultrasound was scheduled for the
following morning. They admitted him and started him on fluids, anti-nausea medication, antibiotics, and pain
killers to help with his discomfort. Low dose aspirin was also administered since blood clots can also develop
with pancreatitis.

The ultrasound showed no other concerns and they continued treating the pancreatitis. Biggles remained
hospitalized for 6 days. He would not eat at all for them and did not use the litter box until they gave him some
valium to relax him. They began syringe feeding him which he seemed to take very well. A feeding tube was
recommended which we were very much against unless it was a last resort option to get food into him. Treating
pancreatitis successfully requires providing good nutrition to the cat. Because Biggles is a very picky eater, we
knew he would not eat what they were offering him voluntarily.

After 6 days he improved considerably and they felt that having him home would help to get him to eat on his
own. They advised a diet of prescription food (Royal Canin Recovery RS) and providing 5 to 6 small meals a
day. We syringe fed him for about a day and then he began to eat enough on his own. We have been feeding
him since his hospitalization, a diet of protein (chicken and beef), and have cut out much of the “treats” that may
have contributed to his disease (cheese, cream). We continued with the low dose aspirin (every 72 hours),
Pepcid A/C (every 24 hours), and Cyproheptadine (appetite stimulant), (every 24 hours) for 2 weeks.

We had a follow up appointment with our local vet 10 days later. Biggles was doing well by then. He weighed 12
lbs 4 oz at that time. There have been a few times that the Pancreatitis had seemed to have flare up, he hid and
vomited a few times. But mostly he had done well with little symptoms of discomfort. I've given him Pepcid A/C
when he seems to have some nausea.

About a month later we thought the pancreatitis was bothering him and called our local vet. Biggles was showing
the same symptoms as he had when he was first diagnosed with pancreatitis and he also was losing weight
quickly. We brought him in and they did blood work and gave him fluids. Ocean state did mention diabetes when
they hospitalized him in August (there was a small amount of spilling of sugar in his urine and mildly elevated
blood sugar, attributed it to stress). Nothing was overly concerning at that time for them to go further with testing.
Biggles had a blood sugar level of over 300 with ketones in his urine. An initial diagnosis of diabetes
ketoacidosis was made by our local vet and we were again advised to hospitalize him. He weighed 10 lbs 6 oz.

Biggles was admitted to Ocean State and given fluid therapy to fight dehydration. A chest x-ray and ultrasound
was done. His x-rays showed nothing abnormal for a cat his age and the ultrasound showed some pancreas
inflammation. But not as bad as when he was admitted in August. After a few days of insulin and fluids, Biggles
was sent home with instructions and the treatment for diabetes was given. Biggle’s glucose levels had come
down and he was responding well to the insulin injections. Biggles will be given 2 injections, of 1 unit of glargine
every 12 hours after a meal. Biggles food (Felidae) was given an okay by his vet for being a good diabetic food.
We will also stay on a high protein low carbohydrate and low fat diet. When Biggles came home he had terrible
diarrhea and then was constipated for a few days. Both issues resolved themselves and have not been an issue
since.

A week after his treatment began for diabetes, a glucose curve was done on Biggles in which he stayed at the
vets for the entire day. The vet was pleased with the numbers and she believes we should stay with the current
insulin dosage. He had a spike of glucose in the morning after his injection, but stayed within good levels (under
200) for a good portion of the day and then nearing his next injection, spiking again over 300. He weighed 10
lbs.

Biggles had a 3 week recheck Nov. 5th, with a testing of his urine. He had gained ½ lb since the beginning of
October and the test showed no ketones in his urine and only slightly elevated glucose levels. The condition of
his coat had improved greatly which was noted by one of the vet technicians. Biggles has been introduced to a
wet cat food, Weruva, the Paw Licken Chicken variety shows to be a good diabetic food and high in protein and
low in carbs. He took to it almost immediately. I am hesitant to try other varieties as the carbohydrate numbers
are higher. Some contain vegetables which he will most likely leave anyway.

Four days later Biggles woke up and was once again lethargic and not eating or drinking. I brought him to the
vets early morning for evaluation. He was running a fever of 103.6. The vet treated him with subcutaneous fluids
and antibiotics. Urine testing was also done in-house. He was sent home with a recheck scheduled later in the
day. Biggles began to show slow improvement throughout the day. He was still not himself when I brought him
back to the vet. Blood work was recommended to look for infection or a possible flare up of his pancreatitis.

He was retaining the fluids given earlier in the day and his temperature had gone down by mid afternoon. The
urine sample showed nothing of concern. She recommended antibiotics for 7-10 days or a long duration
antibiotic injection. It is much more expensive than a bottle of Clavamox, but will ensure that Biggles gets the full
affect. I went with the injection.

The next day Biggles vet contacted me with the results of the blood work which showed some bacteria. She also
noted that there was some indication in his blood work that he had a flare up of the pancreatitis. By that time,
however, he was no longer lethargic and eating and drinking on his own. He will go back in 10 days for more
blood work to check if the bacteria has cleared up.

Update: March 5, 2012
The follow up appointment in November, 2011 showed the infection had cleared up and his glucose and
triglycerides were good. Biggles' vet feels the dosage for his insulin is accurate. We will continue to monitor his
glucose every 4 weeks going forward. Since December Biggles has been treated twice for lethargy and lack of
appetite. The episodes occurred again in early January and then again in late February due to his pancreatitis.
However, an additional issue with trying to regulate his diabetes continues to be addressed.

Fortunately once a change in his behavior is visible, both episodes are very short in duration. Getting Biggles to
his vet and administering fluids has been helpful in limiting the duration and intensity of his pancreatic flare ups.
Usually within 8 hours of administering the fluids he is alert, active, and eating again. Biggles was also given a
shot of diphenhydramine to help with nausea. The sign of a flare up for Biggles begins with him becoming finicky
with the food he does enjoy. Then he only eats a small amount for a day or so. Then he doesn’t want to eat
much of anything and he becomes quiet and withdrawn. Biggles vomited the morning we brought him for fluids.
When he does vomit with a pancreatic attack, it is generally a yellow bile color. Note that he does not always
vomit when he is not feeling well.

We have had his blood tested (glucose, liver, and kidney values) and urinalysis done on both occasions. The
only concerns that were seen were signs again of elevated bacteria in his urine indicating an infection. I allowed
the antibiotic Covenia (January, 2012) to be administered which I have concerns about going forward. We have
not administered any antibiotic as of yet for his most current episode. Other clinical signs showed a fever in
January, but not the most recent time in February. Diarrhea was also seen in the most recent episode in
February. Biggles' vet attributes the reoccurring infections to not having his diabetes regulated which she noted
can bring on urinary tract infections. This most recent episode showed Biggles having a high glucose number
around mid day of over 300. He had a similar reading in January at the same time of day. The initial curve done
in October, 2011 was in the 200s during the same time of day.

Other items of note, Biggles very much enjoys the Weruva cat food variety of paw licken chicken. After a day or
two of eating it, however, he has very bad diarrhea. This is very disappointing because as I have noted before,
this is the only wet cat food he has ever taken to. I can only give it to him in small quantities as a treat. Biggles
most recent pancreatic attack occurred on Tuesday, February 21st. As of today he is eating well, active, and is
only showing a lingering issue of diarrhea.

Update: September 13, 2012
Since the last update given in March, 2012, Biggles has had no pancreatic attacks. Our local vet has provided
us with the medical supplies to induce fluids at home should he become dehydrated and require fluids. But we
have not needed to use it. We have more issues with regulating his diabetes at this point, however the lack of
a pancreatic episode helps to lessen the concern with him not having a meal prior to his insulin shots. Biggles is
now on 5 units of Glargine Insulin twice per day. He began with 1 unit in the fall of 2011. Although his glucose
numbers are better, we are not seeing total regulation. We have done several curves over the last month. Our
vet indicated that we may need to change the type of insulin at this juncture if more consistent results are not
seen. Biggles has gained back a pound of his lost weight. He is alert and active and the only clinical visual sign
of his diabetes is weak legs (neuropathy). But there is improvement in the strength of his back legs.

In April, 2012, our local vet advised us to seek a nutritional consultation. She continued to show concern
regarding Biggles and his aversion to cat food. We also introduced a raw diet. He didn’t love it, but would pick at
it from time to time. We met with a Tufts University nutritionist and she asked that we no longer feed him any
human food. She was also concerned with a raw diet. Because of his diabetes, he would have a lower immunity
to fight against bacteria found in raw meat. She gave us a variety of kibble, he did not like any of the samples.
We were determined to remove the human food from his diet, which ultimately has happened. She also
suggested that we give him more frequent doses of Pepcid A/C and not wait until he is not feeling well. I give him
a dose a few times a month now for maintenance. She felt it okay to give him a 1/3 tablespoon of turkey baby
food, with pulverized Felidae. He cries for it when you show him the baby food jar. He is not given this every day,
but only when he is not as excited about eating just his kibble. We have tried to keep Biggles from grazing
throughout the day, but he still begs to eat at times. We give him a small amount of Kibble to satisfy him at those
times.

Update: March 25, 2013
Biggles has been doing well since the last update in the Spring, 2012. He had one episode in late October, 2012
of what appeared to be a Pancreatic flare up. He was in the “meatloaf” position and would not eat for us during
the morning. We were prepared to give him subcutaneous fluids by noon if he didn’t improve. I did give him ½ of
a Pepcid A/C during the morning. We continue to give Biggles the ½ tablet of Pepsid A/C a few times per month
and not only when he seems to not feeling well as recommended by the Tufts nutritionist. Biggles eats his
approved food of Felidae Kitten/Adult formula, Friskies hairball treats (soft), and Whisker Lickens Tender
Moments treats. He still enjoys baby food which helps to stimulate his appetite. We monitor his diabetes on a
regular basis. He has had several modifications to his insulin injections due to low glucose levels when tested.
His levels have fallen into concern around mid to late afternoon. This is 4 to 6 hours after his injection when the
lowest levels are generally observed. Levels have fallen between 60 -70 mg/dL several times over the winter
months. This was at 4.0 units of Glargine (2 times a day).

To ensure that Biggles diabetes was still regulated, a Fructosamine test was done at our local vet in late
December, 2012. When the fructosamine level is measured, it helps determine the average glucose level for the
previous 2 to 3 weeks. Fructosamine monitoring is often the preferred method for monitoring the glucose level in
cats because it is not affected by stress, which can cause a sharp increase in the blood glucose level and not
give a true reading. The test showed that Biggles had a level of 420 which showed his diabetes was regulated.
Due to concern with Biggles preferred eating later in the morning then when he first wakes up, we have changed
the course of treatment to a graduated level of 3.5 units when he eats an acceptable amount of food and only 2
units when he does not eat enough at breakfast or dinner. Our highest concern is in the mornings when he does
not eat a lot before we have to give him his injection before leaving for work. It is not that he is sick and not
feeling well enough to eat. But he prefers to eat later than 6 or 7 am. Biggles weight is good. (12.9 lbs). The
weak back legs (neuropathy) have resolved and Biggles can jump up to counter height. Biggles is doing very
well and has had little issue with his overall health during the last year.

Living With Pancreatitis - Biggles B.

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