Since last Thursday Tommy had serious bouts of pain which appeared SM related with increased face rubbing, scratching, yelping when touched or when moving etc. The twitching that had been so well controlled by Lyrica and metacam started up again.
He had no sickness or stomach upsets and his motions were as firm as usual.

Clare Rusbridge was away but very helpful as usual in answering emails & giving advice. He needed to be sedated while the metacam cleared from his system and then we started steroids.
Unfortunately the pain episodes did not get any better, he developed an eye ulcer from scratching and I knew that recent blood tests had shown problems with his kidneys.

I decided it was unfair to continue if his pain could only be kept in check by heavy sedation.

I took Tommy to Cambridge yesterday expecting to return without him. Dr Penny Watson, a leading researcher who receives the pancreas tissue samples from the Cavalier Collection Scheme was there to meet us. She was going to euthanize my boy for me.

On hearing that he had very recently been changed to Hills k/d renal diet Penny examined him, found he had a very painful stomach, and felt confident, despite the lack of gastroenteritis symptoms, that the problem is pancreatitis triggered by this newly prescribed high fat food.
She felt the pancreas pain has lowered his pain threshold and made his SM painful too.

So Tom came home again after another sedative injection, with Tramadol painkillers and another change of diet to be gradually introduced.
Penny is checking the kidney results with my vet. If he does have both pancreatitis and kidney problems then he may need a home prepared diet.

Tommy is still quite heavily sedated and he is still yelping occasionally but I find that easier to accept if time and the right diet hold out the prospect of him getting back to a good quality of life.