PANCREATITIS

[Jane, Guinness and Murphy]

After just going through a case of acute Pancreatitis with Guinness I thought it would be helpful to post the things that I've learned about this disease. 

• If your dog vomits more than once (sometimes with accompanying diarrhea, but not always), isn't interested in eating, and is listless or not wanting to move or get up....get him to a Vet.  This is what Pancreatitis looks like in its early stages.  The Vet will often be able to determine if it actually is Pancreatitis through a quick blood test which shows elevated pancreatic enzymes.  Catching this early is critical, and repeated vomiting can quickly lead to dehydration.   We got Guinness into the Vet within the first 12 hours and he was already dehydrated.  While you're waiting to get your dog into the Vet be very careful of any food you give him....low fat only, if anything.
• Pancreatitis is an inflammation of the pancreas...the organ that secretes enzymes that are used in digestion.  When something causes these enzymes to be activated prematurely, they can actually begin to digest the pancreas itself which causes pain and the inflammation.  There are two forms of pancreatitis....acute and chronic and either one can be mild to very severe.  Guinness had acute pancreatitis which occurs very suddenly and is often severe.  Chronic pancreatitis is an ongoing inflammation and often there are no symptoms.
• Acute pancreatitis is extremely painful, so pain management is usually part of the treatment.  I could tell that Guinness was in pain because he kept himself in a "ball" and would not move.  It can be fatal, especially if it spreads to other organs.  The symptoms are loss of appetite, vomiting, weakness, depression, and abdominal pain....sometimes diarrhea but not always.  Because of the nausea, they will often drool or smack their lips....actually the lip smacking was something I noticed right away because Karen's JD had the same symptom with his IBD.
• For mild cases all that may be needed is withholding food and water for 24 to 48 hrs and managing the pain.  IV fluids are usually administered during this period to prevent dehydration.  The thinking used to be that food and liquids should be withheld until the symptoms subsided in order to rest the digestive track, but that thinking has changed.  Now there is growing evidence that recovery time is reduced and survival rates increased when dogs are fed early in the recovery process.  Withholding of oral food and water for more than 48 hrs can lead to "leaky gut" and atrophy of the digestive cells in the small intestine and sepsis.  I learned this from both my regular Vet and the Specialty Vet in the Hospital.  Basically without oral nutrition the intestines starve even if nutrition is provided to the rest of the body through IVs.  This is because the intestines receive their nutrition only from what passes through them.  This was very surprising to me...I had believed that as long as Guinness was getting IVs he was okay.  This is also why there was so much concern about him not eating.  I really think they wanted to keep him in the Hospital for one more day, but getting him to eat was more important, and they felt like he needed to be home for that to happen.  As a last resort, they would have gone to a feeding tube...thank heavens we were able to avoid that.
• Guinness was on lots of meds:  antiemetics to control the vomiting, antibiotics for secondary infection, anti-diarrhea meds, pain management meds, antacids, and a probiotic.  There is apparently a lack of agreement on the probiotics but both of his doctors prescribed them.  A plasma transfusion was considered when he was in the Hospital, but it did not come to that.
• Chronic pancreatitis is a continuing low grade inflamation.  Symptoms are occasional vomiting and loss of appetite.  The symptoms can be pretty non-specific and may go unnoticed.  Chronic pancreatitis can occasionally flare up resulting in acute pancreatitis.  It's uncertain at this point whether or not Guinness has this, but for now we are going to act as if he does.  Often the symptoms of chronic pancreatitis are blamed on other diseases like IBS/IBD.  A low fat diet is key with chronic pancreatitis....I will be home cooking for Guinness for the foreseeable future.
• So what causes pancreatitis?  This is where things get confusing for me.  Clearly a high fat diet is usually blamed for this disease....but I have not been able to find any scientific evidence to fully support this theory. When dogs who ingest something high in fat after being on a low to moderate fat diet they are susceptible.  We assumed that Guinness was triggered by the treats he had at training the prior day.  I have since heard from the trainer and the treats she gave him were only 7% fat and mine were 6%.  It may have been the volume...he did have more than he would normally get since for regular training I don't use treats.  So maybe that's the cause or maybe he has chronic pancreatitis that flared up.  We don't really know.  Low protein diets and certain medications have also been identified as potential causes...these did not apply to Guinness.  There are also some underlying conditions that can predispose a dog to pancreatitis....e.g. diabetes, hypothyroidism, Cushings disease.
• Pancreatitis hits young and old dogs of all breeds, although it is most common is middle to old age overweight and inactive dogs.  I found it interesting that data suggests that Cocker Spaniels and miniature Poodles have an increased risk of chronic and acute pancreatitis. Guinness is an ALD...so he has both breeds in his genetics.
• Diagnosis...Guinness was diagnosed through a blood test which showed significantly elevated pancreatic enzymes.  However, we were lucky.  In some cases, the enzyme levels test normal even though the dog has pancreatitis...actually this happens almost half of the time.  That makes diagnosis a little more difficult and the Vet may decide to just treat the clinical signs.
• Managing your dog through treatment can be a challenge.  Guinness was hospitalized during the day on IV meds and fluids, and he came home at night to sleep.  We did this for four days and when his symptoms were not improving he was admitted to a Specialty Hospital for round the clock care.  At that point his condition was very serious and he needed the care of an Internal Medicine Specialist as well as 24 hr management.  After two days he was able to come home. 

I hope this information is helpful...but that you never need it. 

[Karen, Jasper and Jackdoodle]

Thank you for posting this, Jane. Because of your willingness to share the knowledge you gained from this horrible experience, other dogs may be saved. Something good may come come out of this after all.

 

[Jennifer,Chloe & Myla]

Well done Jane-thanks for sharing!

[Susan and Sasha]

Thank you for taking the time to  share this Jane...

Your heart of love and concern, may be the very thing that might save another dog....and help other people know just what to look for and do when their baby begins to feel sick.

This information is So valuable...and I for one...will keep it handy.

Thank you again...and send our love and hugs to Guinness...

 

 

[Deanna & Desi & Cori]

Such important information - thanks for sharing.  Sorry you had to become a pancreatitis expert the way you did!!

[Laurie, Fudge, and Vern]

Thank you, Jane, for writing this post. It is good information to know!

[shelly]

This is wonderful Jane!  Thank you for posting... other things that I have learned through Tori's episode' was - the vomiting does not have to be continual - in it's early stages, they will vomit, then MAY eat a little, be lethargic, then spark up a bit of energy... this is what Tori did for a couple of  days.  I kept second guessing my self and the feeling that I had that she just was not right... every time I decided I would take her to the vet, she seemed to get a spark of energy, then became mopey again.  By then it was a weekend - so our 'journey' started at the ER... also, something the vet told me... if you gently rub their belly, and they arch their back up... that is a reaction to any pain or tenderness they feel in their bellies and a visit to the vet may be necessary.  like you , we now are very leery of exactly what we give her as far as treats....in our case Tori got into the garbage and ate a few boneless spare ribs from a Chinese restaurant...WAY too fatty!

I am so sorry it took this for you to become so knowledgeable on the topic!   Can ya' tell the Irish Boys, the next time they want you to become knowledgeable on something,  you can just surf the internet.... It's much healthier and less stressful for Mommy that way!  SOOOOO happy all is well!!!

[Elizabeth & Cosmo]

Jane, thank you so much for taking the time to write and organize all this information. You have made a complicated subject so clear and easy to understand. I certainly hope Guinness never has to go through this again!

[F, Calla & Luca]

Thanks for posting Jane. I think knowing the early signs of pancreatitis will be helpful for us all. I am a bit confused about what you said about the nourishment of the bowel. I had never heard this but what I learned was many years ago. But the bowel has a very good blood supply and that is how nutrients get to the rest of the body and how I thought they got to the bowel itself. I think the causes of leaky gut are still somewhat murky.

[Jane, Guinness and Murphy]

I don't really know, F.  It's what both Vets told me and I also found it in some of the literature I saw online.  This is apparently new thinking in dogs with Pancreatitis....they used to withhold food.  They were very concerned that Guinness get oral nourishment.

[F, Calla & Luca]

This is so interesting Jane. Times have changed.

[Jane, Guinness and Murphy]

I'll ask my Vet more about this when I have Guinness's follow-up next week.  I know there is not consistent thinking on this, based on Frances Horan's post....her Vet did withhold oral nutrition.  I'll also go back through what I saw online and see if I can find the info I read last week and post links.  I pushed at it a lot.  It seemed like every time we gave Guinness any food it just triggered the vomiting and diarrhea again.  But my Vet felt strongly that we had to keep trying.  The Critical Care Specialist then said the same thing.  They tried everything to get Guinness to eat in the Hospital....RX food, boiled chicken, and baby food.  Again, it was confusing for me....I couldn't understand why the IV nourishment wouldn't be enough. 

[Karen, Jasper and Jackdoodle]

Here's an article I found about this:

Nutrition during acute pancreatitis Traditionally, the standard recommendation has been to withhold all oral food and water until symptoms subside, in order to allow the pancreas to rest. If symptoms persisted for more than 72-96 hours, nutrition was given parenterally (intravenously, avoiding the stomach and intestines). It was thought that even the sight or smell of food could trigger pancreatic secretions that would make the problem worse.

Today, though, there is growing evidence in both humans and animals that recovery time is reduced and survival rates increased when patients are fed early in the recovery from pancreatitis. It is now accepted that prolonged withholding of oral food and water for more than 48 hours (including the time before the dog was brought in for treatment) can lead to increased intestinal permeability (“leaky gut”), atrophy of the digestive cells in the small intestine, and sepsis (blood poisoning). In turn, sepsis can contribute to multiple organ failure and decreased survival rates.

Without oral nutrition, the intestines starve, even if nutrition is provided to the rest of the body through IVs. This is because the intestines receive their nutrition only from what passes through them. Enteral feeding, in which nutrition is provided through the digestive system, is thought to decrease the potential for bacterial infection caused by intestinal permeation, and may reduce the time the dog needs to be hospitalized.

 

http://www.whole-dog-journal.com/issues/11_11/features/Canine-Pancr...