Pancreatitis and Pancreas Problems 2

Pancreatitis and Pancreas Problems 2

Pancreas problems in miniature schnauzer

Question: Dr. Mike, We have a 2-1/2 yr. old miniature schnauzer, Duffy, that is having some difficulty with his pancreas. We lost a 5 yr. old. two years ago to pancreatitis so are reaching out to stave off this horrible ailment before we lose our precious Duffy. His complaints so far have only been vomiting and elevated lipase. A local vet (not ours) is advocating the use of vitamins C and E as a preventative for pancreatitis in prone pets and we are wondering where you stand on this. Also, we would like to know appropriate dosages if you are aware of this treatment. In one of your letters, you mentioned a vet would look for reddened eye and mouth linings. Can you explain why. Duffy's eye linings are red often and I've been treating them with Neo-predel ointment under orders from our vet. I'm wondering now if this is not the warning sign you were mentioning rather than irritation of some sort. Will eagerly await your answers. I am so glad to have found your site and grateful to you for providing it. Thank you. Vicki

Answer: Vicki- Schnauzers are prone to hyperlipidemia (high fat content in the blood). This condition can predispose affected schnauzers to pancreatitis. It would be a good idea to see if the blood test results included cholesterol and triglyceride levels. If not, testing for these and using a low fat and increased fiber diet might be beneficial -- or it may even be necessary to use medications to control the hyperlipidemia. Dogs having attacks of acute pancreatitis often have visible changes in their mucous membranes (the red tissues of the mouth and eyes). These actually vary, depending on the dog and the stage of the disease, so any change from normal is worrisome. When dogs are in pain and are dehydrated the color is often a ruddy red but some dogs have pale oral color instead. Chronically reddened gums are more likely to be due to dental disease or to be normal for a particular dog. Chronically red conjunctivae (eye membranes) are most often due to allergic conjunctivitis in dogs but also can occur due to eyelid abnormalities, infections and disorder that cause circulatory changes, such as pancreatitis. I really hate to use cortisones in a patient prone to pancreatitis, even topically. It may be worth asking your vet if there is an alternative to the NeoPredef (Rx) because it does contain a cortisone. Unfortunately, if allergic conjunctivitis is present, cortisones do work best to alleviate the discomfort associated with that condition. Sometimes it is possible to use a soothing drop, such as Clear Eyes (tm) instead, though. I do not know whether Vitamin C is helpful in chronic pancreatitis. There is evidence to support beneficial effects for Vitamin E and for selenium in the human literature, though. Since these studies were not done in dogs there are no published dosages for dogs that I am aware of. Vitamin E is pretty safe to use and most guidelines recommend 200 to 800 IU per day. The essential fatty acid solutions like 3V capsules are supposed to be helpful in preventing pancreatitis but there are some reports of dogs developing pancreatitis after administration of these food supplements so it is hard to figure out whether to use them. They may be more helpful when hyperlipidemia is present, so that is another reason to look for that problem. We have had the best luck in controlling chronic or intermittent pancreatitis in schnauzers using low fat diets, keeping cortisone usage to a minimum and advising owners to avoid treats. We have used medications to help control hyperlipidemia in a couple of schnauzers and it did seem to help those dogs. Mike Richards, DVM 7/24/2000

Pain control for Pancreatitis

Question: I was looking for advice about pancreatitis and Dr Mike suggests pain control - but never mentions what might be suitable.

Answer: I like to use meperidine (Demerol Rx) for pain control for pancreatitis. We use the injectable version while they are hospitalized and oral tablets at home if we think we are at a point where oral medications are OK. Sometimes we use flunixin (Banamine Rx) and sometimes we use butorphenol (Torbugesic SA Rx). In a couple of instances we have used fentanyl patches (Duragesic Rx) but usually do not find this to be necessary. Hope this helps some. Mike Richards, DVM

Pancreatitis

Question: Thank you for having such a wonderful reference area to turn to in my time of need. I have spent the last 3 days going through anything that might pertain to my pets diagnosis. The fee is minimal in comparison to the wealth of knowledge. My 5, almost 6 year old Polish Lowland Sheepdog, or PON as they are frequently referred to, has been given several diagnosises over the past three days. When I brought her to our vet on Friday, she had been anorexic for almost a week, drinking excessively and urinating all over the place. She was listless but if stimulated, would chase the cats around and play with her toys. Thursday night she vomited her only meal she had had in awhile and Friday, I knew, something was up. They admitted her right away for IV fluids and testing. Possibility: Cushings Disease. Well, her Alk Phos was elevated at 1300 and her blood sugar was in the 400's. Responded very well to NPH insulin which she remains on. They scheduled an ACTH stim test as well as ultrasound of the adrenals. The ultrasound, done Monday am, showed adrenals to be fine, but showed pancreatitis and dense changes in the liver, almost like swiss cheese is what the radiological vet told me. She said this could be due to the pancreatitis or even a Lymphsarcoma. She had a ultrasound guided needle biopsy and we now await those results. She is now NPO. I wanted her to start on TPN, with the diabetes I know she has to have nutrition for her insulin but the pancreatitis creates the need for NPO. With my primary vet conferring with her internest, (yes, Demi has had her share of problems) we decided to keep her NPO but support her with D5 and NSS, and await the biopsy results which are due back at the end of the week. Her ACTH stim was normal. Know the questions: Have you seen acute pancreatitis occurr in a pet whose only primary problems have been allergies and obesity? She does not get any fatty foods, only Bil-Jac lite, cottage cheese, carrots and apples which she has had her whole life? I am concerned with the diabetes. If the pancreatitis resolves itself, can the diabetes turn around or will the Islet cells be permanently damaged. Should I consider transferring her for TPN? Our vet said she would become a pin cushion as they check her values almost hourly. Can her course of allergy desensitization shots have caused any of this? I knew not to keep her on Pred and she only did 2 tapering courses until we saw the allergist and started her on a desensitization course. She is now on maintenance every 28 days and completely in control. Do you agree with her care thus far? Being a nurse for 15 years, the knowledge base I have completely shuts down when it has anything to due with my "kids". Again, Thanks for a great site on the web! I hope to hear from you soon. Considering I have 3 dogs, 3 cats and 5 birds... I am sure I will be a frequent flyer! P.S. Demi's birthday is 11/3, I hope she gets good biopsy results for her birthday! Don't worry, no cake!! L

Answer: L I am not certain that I have the chronology of the symptoms exactly right, so if I have the events in the wrong order, let me know. I am assuming that there was no evidence of diabetes prior to this most recent problem. If that is the case, there is a chance that the hyperglycemia will be transient or that the insulin requirements could change markedly over the course of the next few days. We have seen two patients with severe necrotizing pancreatitis who developed hyperglycemia during the the initial pancreatitis attack, which persisted for several days (one patient) to several weeks (second patient) but which resolved as the pancreatitis resolved. This severe form of pancreatitis is very challenging to treat and patients can have a lot of secondary problems, including circulatory problems, liver damage, septicemia, kidney damage and even severe blood clotting disorders such as disseminated intravascular coagulation (DIC). I think it is important to monitor blood glucose pretty frequently when using insulin in these patients, but would probably go for two or three times a day rather than hourly, as long as it was possible to monitor her behavior and attitude adequately during the rest of the day. It is also possible that the diabetes was present and contributing to the pancreatitis or that there is a problem such as pancreatic cancer that is contributing to both problems. The biopsy of the liver may help in ruling out cancer but it may also be necessary to get a biopsy of the pancreas itself depending on how things go. Just about everything I hear about total parenteral nutrition (TPN) is positive and if you have the desire to pursue this option I would tend to encourage it. However, we refer patients that require TPN and that limits my "first hand" experience with it somewhat. I have not heard of desensitization as an initiating factor in pancreatitis. I can't find any reference to this in the veterinary databases. So I think it is unlikely to be a problem but can not say it is impossible. Prednisone usage can contribute to both pancreatitis and diabetes but normally this takes chronic use. The longest time we have had a dog stay NPO in the case of pancreatitis and live was fourteen days. Dogs can survive pretty long periods without eating better than most species. But they are still reported to do better with parenteral feeding. I think that more intense monitoring is a reasonable trade-off. It would be worth asking the internist or referral hospital what their usual routine for TPN patients is. That might help in making a decision. Good luck with this. Mike Richards, DVM 11/6/99

Pancreatitis - Chronic

Q: Dr. Mike,

I just found your web site and I thank everyone that has anything to do with it. Sasha, my 7 year old Shepherd, Husky mix has Pancreatitis and we have been dealing with it for 17 days. Her symptoms are very much like those Cutter displayed ( owners Kathy and Steve) and even though I would like to authorize surgery I have already spent $700.00+ and don't know how far I should go. The one symptom that Sasha does have that I haven't read about is weakness in her hind quarters or both right legs. My vet says she might have kidney failure or Cancer since she is so inconsistent with her symptoms and tests. Since I know I have to think about her quality of life, is there anything you can help me with in this area? I'm also wondering how Cutter came out of this. Did the surgery pay off and what did they find. My husband is against spending any more money but I'm having a hard time with just giving up. Also, my vet is away and I am wondering if I should get more pancrenzme as I will run out before he gets back? Sasha is also on Amoxi (400mg), Sucralfate (1gm), and Prednisone (20 mg) every other day. Today is the last day for the Sucralfate and the Pancrenzme. My doctor will be back in 4 days. Since we are very rural, one hour and a half to the next good Vet, I would like to wait for our Vet to get back. I have a tremendous amount of faith in him. I wish to keep Sasha comfortable and if she is going to pass then I want it to be here with me. What would you suggest? Thank you from the bottom of our hearts, Kerstin & Sasha

A: Dear Kerstin I think that you should get some more of the Pancreazyme and use it until you can schedule a recheck with your vet. This is a replacement enzyme for dogs that are deficient in pancreatic enzymes and if your vet is suspicious of this problem it may be necessary to use it for a long time. It is always difficult to decide what to do in chronic pancreatitis cases. I think that your vet will probably want to recheck the labwork and examine Sasha before doing anything else, though. If there are further signs of kidney damage or if there is a more apparent cause of the weakness it may be necessary to revise the treatment plan to account for these problems. We have seen the weakness problem in one or two dogs with pancreatitis. My personal theory is that it is sometimes related to the pain associated with pancreatitis but I have no scientific basis for that theory, it is just a guess. Weakness can be a sign of other problems associated with pancreatitis, such as diabetes and heart disease. It may indicate another problem such as discospondylitis (infection of the discs between the spinal segments) that can sometimes occur when there is a chronic bacterial infection. Your vet may be able to tell more on a recheck. I hope that you are able to help Sasha through this problem. I know it is tough to have to keep spending money for tests and for rechecks but often it is worth the effort. If pain seems to be part of the problem at this point it would be a good idea to consider a pain reliever. I am often amazed at how much good a little pain relief can do for dogs with pancreatitis. Mike Richards, DVM

Pancreatitis in Jack Russell

Q: Hello Dr. Mike: We have a 9-1/2 yr old Jack Russell terrier named "Cutter." He was diagnosed with pancreatitis and it appears to be persistent and we are concerned for him. It started Saturday, April 18 when he vomited, around midnight, a yellow, foamy substance containing some grass. We were busy with company during the day so we were not paying attention to his behavior earlier. On Sunday, he vomited several more times and we took his temp which hovered around 104. We telephoned an emergency vet hospital and they said not to give him food or water and take him to our vet on Monday. We were at our vets at 7am Monday where he was examined, CBC was taken along with x-rays. The x-rays were unremarkable. He was brought home where he later vomited a large amount of a clear liquid and later had diarrhea. On Tuesday, April 21, we called the Vet for results of the blood test: Alkaline phosphatase (433), Cholesterol (431), Potassium (3.0), Pipase (7,650), Amylase (5,080), Triglycerides (352), CPK (804), Magnesium (1.1), WBC (21.4), Absolute polys (18,832). The other tests were within range. They said to bring him in immediately for admission to hospital with acute pancreatitis. The following is a chronology of treatment: April 21, Tuesday - Admitted to vet, given IV of fluids and an injection of antibiotics. Told it would take about 3-4 days to get back under control. He still vomited today. April 22, Wednesday - On IV fluids + antibiotics. Vomited again. April 23, Thursday - Did not vomit for 24 hours so they gave Cutter a small amount of a bland diet food 2-3 times this day and they also took a CBC. April 24, Friday - Early am they called to say the lipase and amylase had gone down, however, the bilirubin had elevated out of range (I cannot recall & we do not have copy of bloodwork. we only have copy of the initial bloodwork.) A sonogram was ordered and done. It showed an extremely enlarged pancreas. We were told they needed to stay on the same treatment of IV fluids & antibiotics over the weekend. If he wasn't better by Monday an internal medicine specialist would be consulted. April 27, Monday - Specialist consulted by our vet. We were informed that there were 3 scenarios to this case. First, that it could resolve itself. Second, that a cyst could form and it could be okay or tumorous. Third, it could become an abscess. We were told that Cutter would likely get to come home by Friday if no more vomiting or fever and Thursday they would do CBC again and try bland diet. Things were looking up. April 28, Tuesday - Again things looking good. No vomiting, normal temp. April 29, Wednesday - Again things looking good. No vomiting, normal temp and he even had a bowel movement while still on IV fluids & antibiotics. April 30, Thursday - Took temp and CBC. Cutter had 106 fever. Changed his antibiotic from (we don't know what) to Amoxicillin and Baytril. Fever hovered at 104+. May 1, Friday - Vet called to say that Cutter's amylase and lipase and bilirubin, were down, however now the liver was up. Had a temp of 105. Vet consulted with internal medicine specialist again who said that sometimes it might just take longer than normal to run it's course and to stay the course over the weekend. At our evening visit, another on duty vet told us she had been reading some other books that afternoon and decided to try a painkiller to bring down the fever and it did to 103. May 2, Saturday - Still has fever. Prior to giving another painkiller, they "palpitated" Cutter's stomach and said he did not appear to be in any pain. Still gave him painkillers for fever. May 3 Sunday - Visited this morning and he still had fever of 103.5. At 5pm this evening, vet called to say fever was 104.5, and after consulting with another vet, recommended that we take Cutter to the internal medicine specialist tomorrow. Cutter does not appear to be improving and we would appreciate any insights or suggestions you could offer. We came across this website while searching the Internet for help. So, if there is a fee, please advise. Worried owners, Kathy and Steve

A: Kathy and Steve- Michal (my partner and web designer for the VetInfo site) forwarded your second e-mail to me, indicating that Cutter is continuing to have problems. I had intended to send you a note because I think that referral to a specialist is a good idea, if for no other reason than to get a good second opinion. I have had cases of pancreatitis that went badly and it does seem like that is what is happening to Cutter, just based on what you sent so far. While I still think that is the best thing to do, the emergency clinic will be equipped to provide intensive care and is a very good interim choice. Pancreatitis can vary in intensity from a one-day bout of abdominal pain to a fatal illness that may linger for one or two weeks before causing death. There does not appear to be any really good way to predict which dogs will recover quickly and which ones will have more severe problems. It is difficult to make a definite diagnosis of pancreatitis but amylase and lipase levels in the range of Cutter's are very indicative of this condition. The history is strongly suggestive, as well. Pancreatitis can induce a number of secondary problems. It is necessary to be ready for problems and to treat them aggressively when they occur. The following is a list of some complications to look for: Bleeding disorders can occur after pancreatitis. Disseminated intravascular hemolysis (DIC) is probably the most serious of these and is responsible for many of the fatalities associated with pancreatitis. It is one cause of jaundice associated with pancreatitis. Pancreatic abscesses and pancreatic cysts can occur after acute pancreatitis. These will usually show up on ultrasound exam, according to the sources I have read but it may be necessary to do repeat ultrasound exams to monitor for these. In some cases the only way to be sure of what is going on is an exploratory surgery. Heart problems, especially arrhythmias, occur during and after attacks of pancreatitis as well. Pancreatitis can lead to kidney failure, probably through circulatory changes and toxins released during the acute phase of the disease. Liver damage can occur following pancreatitis if the bile ducts are obstructed by swelling or if infection or tissue necrosis leads to inflammation of the bile ducts secondary to pancreatitis. This is the other cause of jaundice associated with pancreatitis. It is important to look for blood clotting disorders. If they exist they should be treated aggressively. It is not likely that this is the problem but it has to be considered. It is more likely that there may be a pancreatic abscess or obstruction of the bile ducts. It may be necessary to allow exploratory surgery to be done at this time in order to find the source of the continued problems and to make an effort to treat them. I think it is very likely that this suggestion will come up soon since there continue to be problems. Please consider it carefully as it may be the best hope to handle the situation even if Cutter does not seem like a good candidate for surgery due to the disease symptoms. I believe very strongly in the benefit of pain-relieving medications for dogs with pancreatitis. I think that it is as important, or more important, than almost any other aspect of treatment. Whether it is necessary to do surgery or whether aggressive medical treatment still seems logical to the attending vets, pain relief should probably be part of the treatment from here on out. I hope that you and Cutter both find relief for this problem soon. If you discover that you have questions concerning any specific aspects of Cutter's treatment I will be glad to try to help answer them for you. Mike Richards, DVM

Pancreatitis and Diet

Q: Hello Dr. Mike, I have a bedlington terrier that is almost 3 years old. Several months ago he had all of the symptoms of pancreatitis and I rushed him to the vet and that is what he had. I know what set it off. I am training him for obedience and use food and toys for "motivation" and I was using liver (fresh, boiled). the following morning he was very, very sick. Prior to that (months before) I had changed his dog food and he had stopped eating every once in a while, but the manufacturer of the food (Sirius) told me that the food is highly nutricious and I was over feeding him and I should decrease his food intake. That still didn't work so I got rid of the dog food. Now I know that it was probably pancreatitis, caused by the high levels of fat and protien in the food. I have contacted several doog food companies and asked them if they have any suggestions as to what I should feed my dog. It seems that they all feel that they do not have a dog food appropriate for my dog. Spanky (the dog) will be three years old in September. He is not over weight at all and he gets a lot of exercise. I generally run him 2 miles a day, 4-6 days a week. He runs with my other bedlington, a border collie and miniature schnauzer. I have been feeding him Purina "Fit & Trim". Purina told me that the food is probably not what he needs as he is young, thin and active, but since he has been on this food he has been fine. I also give him a spoonful of yoghurt as that has really seemed to help. I guess the yoghurt is good for his digestive system. I buy the plain, low fat yoghurt. Is there any dog food specifically made for animals with pancreatitis? I would like to get him off the Fit & Trim, but at the same time my heart tells me "if it isn't broken, don't fix it". I am just worried that he is not getting all of the nutrition that he needs. Also, Spanky is biopsied normal for copper toxicosis so that is not an issue. Please e-mail me with you opinion as to what you think I should do. Thank you very, very much, Robyn & Spanky

A: Robyn- I think that a consistent diet is important for dogs with a predisposition towards pancreatitis. I like Fit and Trim and Cycle Lite because they are lower in fat and higher in fiber than most dog foods. I am reasonably certain a three year old dog will do fine with either of these foods. At present the value of fiber in control of pancreatitis is questionable but I don't think it hurts. Hill's w/d diet has been recommended for pancreatitis by veterinarians assuming that fiber will help. Purina makes a food for dogs with pancreatitis but is sold through veterinarians. It is not a high fiber diet but follows the logic that easily digested foods are less work for the pancreas. Their diet is called Canine EN formula. The Hill's diet in this category is i/d. I am not convinced that there is enough value in changing diets to recommend it for most of my patients with pancreatitis who are eating one food consistently. If they are eating all tablescraps or inconsistent diets I do recommend going ahead and trying one of the above diets. So the short answer is that I see no real reason to change diets if he is doing well on Fit and Trim. Mike Richards, DVM

Acute pancreatitis

Q: Our dog, Max has been diagnosed with acute pancreatitis and is in a really bad way. Our vet has said that it may be due to a tumour, in which case things don't look good. My question is this, I have read that pesticides can bring on pancreatitis in dogs and we live next to a farm (where Max frequently wanders) - could the pesticides the farmer is using be at the root of Max's illness? Max has a history of nail-bed and ear infections that the London Royal Vetinary College skin-disorders lab could throw no light on, could this be linked? Due to the infection history, we asked the farmer which pesticides he uses. He won't tell us! He does say though that they conform to all UK laws etc. and that he has a dog and would not use anything harmful. I am not satisfied with his answer! We also have Max's sister here (who is in good health) and are worried that if pesticides are to blame she will be exposed as well. Thanks for your time, Nick.

A: Nick- I am on the road, away from my clinic and do not have access to all of my references but the only herbicide I know of that has been connected with pancreatitis is Paraquat (I think this is a trade name). I am not aware of any connection between insecticides and pancreatitis but can not be sure there isn't one. If corticosteroids have been used to treat the nail-bed infections/inflammation they can potentially increase the possibility that a dog will develop pancreatitis. In some cases nail-bed and ear problem arise from immune mediated disorders and there is a chance that an immune problem could lead to pancreatitis as well. I hope Max made it through the pancreatitis problem. It would be good to limit is wandering in any case -- other things he might find while wandering could be leading to pancreatitis (like high fat treats from a well meaning neighbor or availability of high fat garbage somewhere. Keeping his diet consist will help prevent recurrences. Mike Richards, DVM

Pancreatitis

Q: My 8 year old Bichon Frise was lethargic, and had stopped eating. Our vet ran some blood tests and her Amylase value was 12,500. (Her WBC was slightly elevated, but rest of blood work seemed normal) He diagnosed pancreatitis and prescribed amoxycilin and Pepcid AC. She has been on prescription diet food (Hills I/D) for quite a while because of a finicky stomach, and she had not eaten anything unusual during this time frame --certainly no table scraps. Is this standard treatment for pancreatitis? Would there be other reasons for such a high Amylase value? Is this condition serious, and what can we likely expect? Would you be doing anything differently?

A: Amylase rises occur for two primary reasons, pancreatitis and kidney disease. It may rise with some other less frequent conditions but not to extremely high levels and 12,500 is a very high amylase level. I am assuming that the labwork did not show evidence of kidney disease and therefore your vet assumed pancreatitis was present. We usually treat pancreatitis by withholding food for 24 to 72 hours, depending on what happens during that time period. We give fluids by subcutaneous or intravenous means and use antibiotics, pain-relief medications and other medications as indicated by the dog's condition. It is possible that your dog was doing well enough, based on physical exam, that your vet felt the worst of the pancreatitis was over with. Amylase levels stay high for a few days after dogs are over the acute disease many times. Pancreatitis varies from a fairly minor problem, responsive to just not eating for a day or so, to a serious, fatal illness. It has to be taken seriously whenever it occurs but most of the time dogs will get over it. It is more frequent in dogs who have experienced it before, so keep a close eye on your Bichon in the future. Mike Richards, DVM

Pancreatitis, inherited tendency possibilities

Q: Dr Mike, Can Pancreatitis or general pancreatic problems be caused by a virus? Is it a genetic problem? If so, is the way known it is passed on? Thank you for help.

A: To the best of my knowledge, there is not a viral cause of pancreatitis in dogs and bacteria are only rarely, if ever, thought to be involved in initiation of the disease. In cats, I think there is some suspicion that feline infectious peritonitis virus can affect the pancreas but it is generally causing havoc everywhere so that isn't too specific an effect. In cats it is thought that toxoplasmosis (a parasitic infection) can cause pancreatitis in some instances. The only hereditary cause that I know of is hyperlipidemia (too much fat in the bloodstream) which is an hereditary condition in miniature schnauzers. This makes them prone to pancreatitis but it still usually seems to take other factors to actually cause the onset of pancreatitis. I do think that pancreatitis tends to follow family lines in dogs but that is just my personal opinion. That probably happens because the risk factors, like obesity and Cushing's disease also follow family lines. But again, that is strictly my theory, totally unproven in any way! Mike Richards, DVM

Last edited 04/12/07