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. 

[Linda, Charlie Brown and Beau]

Laura~ I am so sorry to her your doodle is not feeling well. Hopefully, she will be back to feeling well very soon.

[Lauria Orr]

Thank you, Linda!  Today has been a better day.  I was pretty scared this past week!  We saw the Internist today.  He is really smart and explained things very well. Melody doesn't seem in danger of being in the percentage of dogs who do not survive this kind of incident.  We have to wait to see what transpires, though, to determine what kind of changes we might need for her down the road.  It may be acute peritonitis, it may be chronic, or it may be an autoimmune issue with her bowel. At least for now she is safe...we can live with adjustments!

How are you?????  

[Linda, Charlie Brown and Beau]

So happy to hear she is doing better.  I see you are from the Portland area - we are not that far from each other - we live in Richland WA. 

[Lauria Orr]

Linda!  Yes, we are in Portland.  Coming up your way on Aug. 27th for a concert!  How are you?????

[F, Calla & Luca]

I just saw this and I am very glad Melody is feeling better. I hope she fully recovers quickly.

[Lauria Orr]

pancreatitis, not peritonitis!

[Nancy, Ned, Clancy, and Charlie]

Lauria, I am so sorry to read that Melody is unwell.  I hope, like Jane's Guinness, this is the only episode she has.  Please keep us posted.

[Ricki and Tara (doodle)]

I'm so sorry to hear that Melody has been ill.  Please let us know how she is doing. 

[Lauria Orr]

Hello there!

Thank you for your kind interest in my Melody.  She continues to do well.  A week into this, her brother Morgan started vomiting and also had bloody diarrhea, like Melody.  His pancreatic enzymes were 4X higher than Melody's and I was petrified.  We did home SQ fluids with them both, and after 2 weeks and one day, Melody finally had some oral fluids....about that long after Morgan was ill, he followed suit.  They are both eating, drinking, having normal bowel movements and peeing.  I hope there is no recurrence, and we still do not know what happened. The only abnormal tests were white blood count and pancreatic enzyme elevation. Exposure to organic phosphates, cultures, parasites,etc. were clear. I watch them like a hawk when they are outside.  They eat Taste of The Wild Fowl, and I have changed that in the case it might be too rich. It is one day at a time, and we are pleased they seem more themselves than ever!  Thank you again......

[Jane, Guinness and Murphy]

Glad to hear this.

[Ricki and Tara (doodle)]

 Morgan too??? Oh my! So glad to hear that they are both doing well now. What a scary time for you!  

[Nancy, Ned, Clancy, and Charlie]

I am very glad that both dogs are doing well. It must have been something contagious since they both got it?