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. 

[F, Calla & Luca]

Fascinating really. One just keeps learning.

[Jane, Guinness and Murphy]

Yes, I did read this one....and there's another one too.  I'll look for it.  Thanks, Karen.

[Jennifer and Jack]

Thank you so much for sharing! I have been waiting for this to read it! I still feel a little confused as to,what triggered the attack. It scares me that a few extra treats can do that? My moms dog Molly is very ultra sensitive to food and she vomits very easily if she has too many treats. I have warned my mom but I don't know exactly what to tell her to stay away from.

Thank you for helping us learn. I appreciate it so much. We realized,we need to do better about higher fat treats!

Again i am so,grateful that Guiness is doing so much better!

[Jane, Guinness and Murphy]

I would be very careful of the treats....especially if she vomits after she has had them.

[Jennifer and Jack]

It isn't any specific treat, it is just anything more then one or two!

[Karen, Jasper and Jackdoodle]

Jennifer, I know that recently you posted a discussion about your Jack's weight and mentioned that your mom had been giving the dogs "very bad treats and high calories meals".

You are just going to have to explain to her that it is very dangerous to give dogs high fat foods or treats of any kind. Rather than trying to explain what not to give, tell her what to give. List two or three brands and tell her a certain amount per day, or at one time, etc.

 A "high calorie meal" would have to mean that either 1. she is overfeeding, which is easy not to do: you just measure the food carefully, or 2. she is feeding table scraps, etc.   She is an intelligent woman, I am sure if you explain to her that this kind of feeding is not a kindness, it can kill Molly, she will take it seriously.

[Frances Pendrous (Horan)]

Hello Jane. What an amazing concept to turn your experience around and share the details with others so that, hopefully, if and when their dogs start to show symptoms, it can be nipped in the bud so to speak. When my Johnny first start vomiting, thought he had a bone (we used to give them marrow bones as a treat) stuck in his intestines. Poor dear, had to go through a barium swallow and xrays prior to getting the diagnosis of pancreatitis. I have always felt so guilty for this as it was such an unnecessary test, had they done the blood work first, which would have shown the elevated enzymes. Sadly, the day I took him in, his regular vet was on vacation and a "stand in" vet managed his care, which I feel now was a bit inadequate. Anyway, with all the information you have posted, if anyone goes to this site, they will be able to take this journey with education on their side...thanks to you. I am soooooooooo happy this is finally at an end and, as I said, you made it through it. Johnny does eat the RX diet so I don't have to home-cook for him, but it is incredibly expensive, so we only give it to him when he has a flare-up which he has had about four times since the original onset. Maybe your Guiness will never have another bout of this wretched ailment, but if he does, I know you are totally prepared to handle it. Thanks for being a super-star and keeping us all posted.....WE all never stopped praying and lifting you up. Blessings..Frances and gang xxxx

[Jane, Guinness and Murphy]

Frances, you have been amazing in sharing your insights on Pancreatitis...plus you have been a wonderful support to me.  I so appreciate it. 

[Mara, Sadie & Zoe]

Thanks so much for taking the time to give out all you have learned. So glad that Guinness is feeling better.

[Nancy, Ned, Clancy, and Charlie]

Thank you so much for taking the time to post this while the details are fresh in your memory.  I know you need to spend lots of time lovin' on Guinness right now.

[Leslie and Halas]

Thanks for putting this all in a discussion and for sharing your experience as you and Guinness were going through it. This is really great information to know. I'm so happy that Guinness is going to be OK! I hope this doesn't turn out to be chronic.

[Nancy, Ned, Clancy, and Charlie]

I have a question about the newer thinking for the need for oral nutrition.  Does this mean that under any circumstances  of withholding oral nutrition this can happen, not just pancreatitus?