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Pancreatitis and Pancreas Problems
Pancreatitis - General information
Diagnosis of Pancreatitis in Dogs
Treatment of Pancreatitis in Dogs
Preventing future occurrences of pancreatitis
Pancreatitis Whys
Pancreatitis - What are the possible causes
Pancreas and Liver disease - feeding raw pancreas
Pancreatitis in Boxer with CRF
Pancreatitis
Elevated lipase and amylase levels- pancreatitis possible
Pancreatitis - feeding people food after a bout
Pancreas problems in Min Schnauzer
Pain control for pancreatitis
Pancreatitis
Pancreatitis - chronic
Pancreatitis in Jack Russell
Pancreatitis and Diet
Acute Pancreatitis
Pancreatitis
Pancreatitis, inherited
also see Renal failure
also see Bloodwork
also see Liver problems
also see Bowel Problems
also see Diarrhea
also see Digestive Problems
also see Pancreatic insufficiency
Pancreatitis, General Information
Pancreatitis is inflammation of the pancreas caused by leakage of active digestive enzymes into the pancreatic tissue. This causes various clinical signs but most pets affected by acute pancreatitis have abdominal pain, depression and decreased appetite or lack of appetite. Vomiting and diarrhea occur in many dogs with pancreatitis. In severe cases of pancreatitis there may be signs of shock or total collapse. Chronic pancreatitis in dogs may occur, with similar but less severe symptoms. The signs of acute pancreatitis similar to those seen in dogs are not as common in cats and probably account for less than 25% of the cases of pancreatitis among felines. Cats are more likely to have chronic pancreatitis, characterized by a decrease in appetite, lethargy, loss of weight, chronic vomiting and low body temperatures. Cats sometimes have diarrhea or difficulty breathing.
The pancreas has several jobs that it performs for the body. The pancreas produces digestive enzymes that break down food into molecules that can be absorbed from the intestine. Special clusters of cells in the pancreas, the islets of Langerhans, produce insulin. Diabetes occurs when these cells do not function properly or when they no longer function at all.
It is unusual for acute pancreatitis to cause acute diabetes mellitus and unusual for chronic pancreatitis to lead to diabetes mellitus, but there are cases in which these things happen. These complications are much more common in dogs than in cats. It is particularly important to be aware of the possibility of diabetes occurring with severe acute pancreatitis and just as important to remember that this is usually a temporary situation. It is critical to monitor insulin needs very closely if an attempt is made to correct high blood sugar using insulin in a dog with acute pancreatitis, in order to avoid the risk of shock due to an over dosage of insulin when the islet cell function returns and the pancreas begins to make insulin normally.
Digestive enzymes produced by the pancreas are capable of digesting the dog or cat's body just as well as they digest food. For this reason there have to be very good self-protective mechanisms in the body to keep the digestive enzymes from leaking and to deactivate them when they are leaked. Both of these mechanisms have to work well in order to prevent pancreatitis. There are a large number of things that can interfere with the protective mechanisms of the pancreas.
Pancreatitis is more common in overweight pets. When pancreatitis occurs in an overweight pet it is more likely to cause serious illness, as well. This is one of the many good reasons to keep your pet at or close to its ideal weight.
High fat diets, especially in combination with low protein intake, appear to contribute to the development of pancreatitis. A single high fat meal may cause pancreatitis in a pet whose normal diet is moderate or low in fat. We see an increase in cases of pancreatitis around Thanksgiving, Christmas and Easter almost every year, presumably due to the ingestion of high fat leftovers from the big meals associated with these holidays.
There are a number of drugs that have been linked to pancreatitis. The most well known of these, prednisone (or other corticosteroids) apparently doesn't actually lead to pancreatitis, at least according to recent information in humans (J.M. Steiner, 2005). The medications most suspected of causing pancreatitis include azathioprine (Imuran Rx), potassium bromide (used for seizure control), l-asparaginase ( a chemotherapeutic agent) and zinc used as a dietary supplement. There are a number of other medications that are sometimes mentioned as possible causes of pancreatitis but the relationship with it is less clear for most of those medications. Pets living in areas in which scorpions occur may develop pancreatitis after scorpion stings. Naturally occurring hypercalcemia ( too much calcium in the blood stream) can lead to pancreatitis and it is likely that over supplementation with calcium or calcitriol could also lead to pancreatitis.
It is unclear whether there is a genetic predisposition to pancreatitis in dogs. Pancreatitis is much more common in miniature Schnauzers than in most other breeds but this could be due to a genetic predisposition to hyperlipidemia (high fat content in the blood stream) rather than a direct genetic link to pancreatitis.
The most severe form of pancreatitis is referred to as necrotizing pancreatitis, which basically means pancreatitis in which the damage is so severe that portions of the pancreas are being killed. Some authors refer to this as hemorrhagic pancreatitis. This form of pancreatitis can be fatal and requires early intervention and aggressive treatment when it is present. Dogs with necrotizing pancreatitis usually look severely ill and are usually in obvious pain or extreme discomfort. Cats are extremely depressed and won't eat but may not show much else even though the pancreatitis is very severe.
Diagnosis of Pancreatitis in Dogs
Pancreatitis in dogs causes a number of changes in routine blood counts and blood chemistries. Taken in concert these changes can be highly suggestive of pancreatitis but do not definitely confirm its presence and can not be used to completely rule it out. Mild to moderate increases in white blood cell counts generally occur with pancreatitis. Serum amylase and lipase enzyme levels are often three times normal in dogs with pancreatitis, although these enzyme levels can rise for other reasons and do not uniformly rise in dogs with pancreatitis. Rises in liver associated enzymes, particularly alkaline phosphatase and alanine transferase (ALT) may occur in conjunction with pancreatitis. Mild rises in blood sugar and mild to moderate decreases in serum calcium levels sometimes occur. Some dogs will have moderate to severe rises in blood potassium levels. When several of these changes occur at the same time pancreatitis is very likely.
The most accurate blood test for canine pancreatitis at the present time is the canine pancreatic lipase immunoreactivity (cPLI) test. This is a specialized blood test that is only run at the current time at the Gastroenterology Laboratory at Texas A&M University. Some commercial labs offer this test but they just provide a convenient way for veterinarians to get the blood to Texas A&M.
Radiographs (X-rays) are not highly specific for detection of pancreatitis. There are some subtle changes that can occur when pancreatitis is present but X-rays are at best a supportive test for making the diagnosis of pancreatitis. Ultrasound examination, when performed by a good ultrasonagrapher, is a good way to diagnose pancreatitis but even the best ultrasonagraphers can only detect pancreatitis about 70% of the time and false positive findings may be common with less experienced sonagraphers.
Pancreatic biopsy is considered to be the definitive or "gold standard" test for pancreatitis. In general most vets want to avoid exploratory surgery to obtain pancreatic tissue for biopsy but if surgery is necessary pancreatic biopsy is possible.
Dr Mike Richards, DVM
9/2005Treatment of Pancreatitis in Dogs
For dogs there are two cornerstones to treatment for pancreatitis, control pain and control fluid and electrolyte disturbances. If these two things can be accomplished the prognosis for living through the pancreatitis improves a great deal.
There are a number of pain control medications which can be used in dogs with pancreatitis. The most commonly used pain relievers are probably meperidine (Demerol Rx), fentanyl patches (Duragesic Rx) and morphine but there are several other medications that can be used. The most important thing is to use some kind of pain relief medication. For severely ill dogs the use of continuous IV pain relievers or injection of local anesthetic (lidocaine) into the abdominal cavity along with sufficient fluids to make sure that it spreads everywhere can be very beneficial. This type of therapy is most common at critical care centers and veterinary schools and there is some advantage to asking for referral to a critical care center when a dog has severe pancreatitis.
Most dogs with pancreatitis benefit from fluid therapy designed to keep their electrolytes within normal ranges. Low potassium levels are a common problem in dogs with pancreatitis but high potassium levels can also occur and are more dangerous for the dog. Keeping a dog well hydrated makes him or her more comfortable and aids in the recovery from pancreatitis, as well. Severely ill dogs may also benefit from administration of plasma to ward off the disseminated intravascular coagulation (DIC), a severe form of shock that sometimes occurs with necrotizing pancreatitis. It is necessary to monitor electrolytes and acid/base balance to choose the best possible replacement fluids so dogs who have pancreatitis may need repeated blood work over the first few days of treatment.
Dogs do not usually require antibiotic therapy when they have pancreatitis but there are exceptions to this rule. If the white blood cell count gets very low or very high, body temperature very high or if other signs that a secondary infection may be present occur it is acceptable to use antibiotics. If vomiting is severe the use of medications to control vomiting may be necessary. In general it is probably better to wait to see if vomiting self corrects, as this is a good prognostic sign and also is an indication that it is acceptable to give fluids and food orally.
For almost my entire career in veterinary medicine the standard feeding advice for dogs with pancreatitis was simply to avoid feeding them while there were clinical signs of acute pancreatitis present, even if they didn't eat for a week or more. This philosophy is changing, mostly due to the results of some studies in humans that show an improvement in survival rates and recovery times among patients who are fed early in the recovery from pancreatitis. At the present time it is reasonable to give oral fluids and to feed dogs once the vomiting stops. Small amounts of a low fat food are best. For dogs who will not eat on their own there is evidence that implanting a feeding tube directly into the small intestine (jejunostomy) seems to be beneficial but is usually something that is done more commonly at critical care centers than general veterinary practices.
There may be some benefit to supplementing pancreatic enzymes orally using products such as Viokase (tm). This has not been proven in dogs but human studies show some benefit in pain relief from supplementing enzymes. This is probably due to a feedback mechanism in which the presence of digestive enzymes in the intestines shuts down the release of digestive enzymes from the pancreas, limiting the damage to the pancreas.
Some dogs who have chronic pancreatitis will have fairly frequent attacks of mild abdominal pain. It is often possible to wait these symptoms out and not to provide treatment, as long as the dog doesn't seem to be in too much pain or to be too ill. I prefer to go ahead and dispense pain relief medications for these dogs and to start them early but there is no way to know if this is the ideal practice at this time.
Preventing future occurrences of pancreatitis
In dogs there is a general consensus that a low fat, moderate fiber diet is helpful in preventing future occurrences of pancreatitis. In addition to diet, weight control is a very important factor in controlling the incidence and severity of future attacks of pancreatitis. Overweight dogs seem to have more severe bouts of pancreatitis when it occurs and to have recurrences more frequently. Dog breeds, or individual dogs, prone to hyperlipidemia, especially miniature schnauzers, may also benefit from the use of statin medications, such as Lipitor (Rx) to control the lipid levels in their bloodstream. This has not been proven at this time but reports from vets trying these medications on an experimental basis seem positive -- just remember that anecdotal evidence is always suspect and that this is an experimental therapy.
Question: Dr. Richards,
Why do some dogs come down with pancreatitis? How serious is this malady?
Is there a cure? Does diet have anything to do with the onset of
pancreatitis? If so, what are some of the foods and cooking metholodogy
that need to be avoided?Tony A.
Answer: Tony-
When pancreatic cells are damaged enough to leak digestive enzymes, pancreatitis occurs. There are some recognized predisposing causes but many dogs develop pancreatitis without having one of the predisposing causes and I do not know what triggers the pancreatitis in these dogs.
The known predisposing causes are obesity, high fat diets, ingestion of large amounts of fats as a novel event (like a dog getting into a bag of chocolate candy), hyperlipidemia (common problem in schnauzers), long term use of corticosteroids, Cushing's disease, drug reactions (azathioprine sometimes triggers pancreatitis), blood clotting disorders and trauma. Liver disease sometimes seems to trigger pancreatitis but it may be that there is a common inciting agent in these cases.
We see cases of pancreatitis after almost every holiday in which big family meals are cooked. Ingesting a lot of ham seems to be a common history. I am not sure if other vets think that high salt treats can cause pancreatitis but we think there is some correlation with high salt ingestion, too. Avoiding feeding the dog table scraps at family gatherings would cut down on the cases of pancreatitis we see. I think that when there are a lot of people present, the dog just gets more treats because there are more people to provide them.
Moderate fiber, low fat diets may help to prevent pancreatitis.
Mike Richards, DVM
9/28/2001
Pancreatitis - What are the possible causes
Question: Dr. Richards,
I know a little something about pancreatitis. What I need to know is to
what extent diet could be held as the culprit for the onset of
pancreatitis. I understand that cooking food in some kind of fat (butter
or oil) can be a cause of pancreatitis occuring. Could this be true? I'm
just wondering what other causes there are and if there are other
preventative measures that can/should be taken to minimize the possible
onset of pancreatitis. And what are the remedies?Tony A.
Answer: Tony-
The only recognized dietary cause of pancreatitis that I am aware of is feeding high fat foods or treats to dogs. In our practice we think there may also be some correlation with high salt content but that is just an observation and may not be true. In one study of the effect of high fat diets (Hall, 1989) on pancreatitis, the diet used was also low protein and I am not sure if that is also necessary in order to increase the risk of pancreatitis or if the high fat alone is enough.
High fat diets apparently cause release of pancreatic lipase in the microscopic circulation of the pancreas which digests fats in the blood causing release of damaging fatty acids, which cause inflammation and release of more lipase, which eventually starts to digest the pancreatic tissue, leading to the severe inflammation that causes the signs of pancreatitis.
Non dietary predisposing factor for pancreatitis include being a miniature schnauzer, a Himalayan cat or a Shetland sheepdog, chronic corticosteroid use, having high triglyceride and/or cholesterol levels in the blood stream, having hyperadrenocorticism or hyperparathyroidism (due to high calcium levels) or being obese.
This is one reason to control obesity in pets whenever possible, since it is the most preventable of the inciting causes. Avoiding high fat meals and treats is also a good idea. Keeping corticosteroid use to the lowest necessary levels is always best. Other than these things, I don't know of any useful preventative measures for pancreatitis.
Mike Richards, DVM
9/18/2001
Pancreas and Liver Disease - feeding raw pancreas
Question: Dear DR. Mike,
Over the past half year you have given great counsel on my Pomeranian
Woofy's pancreatitis and liver disease. Although very expensive and time
consuming, we think his quality of life has been great (as far as we
know)and that has been worth it for us. This is the second month of
Woofy's blood work showing a loss of protein and now there seem to be
other changes that are not looking so good either. We just have gone
through another bout of vomiting and food refusal and now I alternate
hand feeding him turkey diced and dusted with Prozyme, then squirt Beef
flavored Vivonex down him ( the turkey serves as reward for being a good
sport about the Vivonex). Other than Tagamet and Urisidiol,we have
discontinued antibiotics Baytril and Amoxicillen (he has also been on
Metrodiazonole, Clavamox, and Denosyl at one time or another) as this
only seems to upset his stomach more. I told Dr Paulsen I am tired of
pilling and dosing a shaking dog.We had an ultrasound done around thanksgiving that showed his pancreas
is continuing to calcify and that there is thickening and changes in the
bowels. At that time we changed his food to Purina's EN as Dr
Remillard's homemade diet was no longer being processed even with
Enzymes. Enzymes! When he gets sick he refuses them on anything and that
goes for Prozyme and particularly Viocase. Now my pharmacist tells me
that he has had success compounding Viocase with fish oil and making a
paste that the dogs lick off their paws. He also swears that Woof won't
get ill from the antibiotics if he compounds them. We know that was not
the case when they compounded the Metrodiazanole.I have been told that nothing is going to really help him in the long
term. If he survives at the very least he will be a diabetic. But no-one
has told Woofy all this. He is still very alert, still playing with his
friend Shamu and having his way with his toy. He does not walk far, but
when he gets his leash on he has every intention of doing so. I just
don't want to give up unless it really is hopeless, on the other hand I
don't want to be foolish or cruel either. One way or another he will die
in his sleep.Is there any point to compounding the antibiotics and trying again? I
thought I would at least try the Viocase compound as we don't want him
to starve to death, and obviously the current feeding routine is not a
high quality of life. I trust Dr.Paulsen implicitly but I think he is
thinking of us now even more than Woofy. The attachement is Woofy's
latest bloodwork please give us the benefit of your wisdom.I do so hope that one day for your subscriber's you will write a long
article on what can happen when owner's indulge their dogs with human
food or give high fat and protein "treats " as are so many of the
jerkies and chews like sow's ears. Robert and I thought if it came from
the pet supply warehouse it had to be o.k.!I hope you are feeling better, We wish you a healthy 2001.
Teal
Teal-
One thing that I have forgotten to mention, that came up in a recent email
from another subscriber, is that it is possible to supplement digestive
enzymes by feeding pancreas tissue. This may be helpful in pets that are
sensitive to pork, since Viokase (tm) is derived from pork. Most dogs
readily accept pancreas, which may also be called "sweetbreads". I am
assuming this is a euphemism left over from a time when people did eat all
the parts of the beef and had to convince children certain parts were
edible when they didn't seem to be. The only problem is finding a source of
the pancreas. Apparently, the pancreas is not considered to be an edible
portion of the beef and slaughterhouses may require a medical authorization
in order to sell the pancreatic tissue, in the U.S. If you can find a
local butcher, this may not be a problem. If that is the case, feeding
about 3 ounces or so of the pancreas per day. It has to be fed raw but it
does not hurt to freeze it and the enzymes stay viable for several months
frozen. It is just an additional option that Woofy might like better than
the enzyme powders.I tend to think that most of the side effects of antibiotics still occur
when they are compounded, so if the vomiting is a direct side effect of the
medication it will probably still occur. I do think a few dogs vomit due to
the taste of medications and I can see where compounding would help in that
situation.The only thing I saw on the lab work that you didn't seem to be addressing
was the high blood sugar. It may become necessary in the near future to
consider insulin therapy. It would be good to at least monitor the blood
glucose, since it was over 200 mg/dl.I know that there are three Dr. Paulsons in California, but one of them is
a classmate of mine (Roger Paulson).I wish that I could offer more help.
Mike Richards, DVM
1/15/2001
Pancreatitis in Boxer with CRF
Question: Hello, Dr. Richards!
More questions have arisen, re the usual progress of CRF. Over this past
weekend, Trudi has experienced a boute of acute pancreatitis, for which
she rec'd sub-Q fluids and anti-nausea injections. She's presently on a
prophylactic dose of amoxycillin for a week. She's made a dramatic
improvement so far.If you remember, Trudi is the Sp. F. boxer who was diagnosed as having
congenitally malformed (medulla) kidneys, resulting in CRF. We've been
managing her quite well on regularly scheduled cimetidine , Rocal, and a
diet consisting of 1/2 canned k/d and half home-cooked renal diet.Now, we're aware that acute, end-stage renal failure causes ketosis,
resulting in that awful sweetish breath, and we've also been told that
there usually are ulcerations present in the mouth. But what we can't
seem to find out is whether this attack of pancreatitis is (closely)
interwoven with the kidney disease. Is it a common occurrence in cases of
CRF. It is *bound* to have done severe damage to her already-compromised
kidneys.At the moment, we are still limiting Trudi to five 1/2-cup servings
(spread out over each day) of a home-cooked rice gruel........plain boiled
rice, mashed with water and a tad of chicken bouillon flavoring. How long
would you recommend staying with this dietary regime......in order to give
the pancreas time to recover? (And no, Trudi has not gorged
on anythng, nor had a diet the least bit high in fat!)TIA for your input on this discouraging subject, Dr. Richards!
Regards, Rozanne
Answer: Rozanne-
I don' t know of a syndrome involving renal failure and pancreatitis in
dogs except for cases of leptospirosis (a bacterial infection), in which
both problems are sometimes caused by the infection. That doesn't
necessarily mean there isn't one --- there are lots of conditions that
occur in just a few dogs that I am not at all familiar with. Pancreatitis
does sometimes cause increases in serum calcium levels and if that occurs,
extra attention to fluid therapy and possibly the use of furosemide (a
diuretic) to protect the kidneys might be worthwhile.We have had several instances of pancreatitis in patients that also had
pre-existing renal failure and we haven't seen highly noticeable changes
in long term kidney function as a result of these episodes as long as
adequate hydration was maintained during the pancreatitis problems.I wish that I had more information that I could give you but I'm hoping
that Trudi's experience will match our previous cases and this will be only
a short term setback.Mike Richards, DVM
9/26/2000
One of the functions of the pancreas is production of digestive enzymes. These are the enzymes that break down ingested foods into molecules the body can digest. These enzymes are carefully handled by the pancreas in order to prevent them from damaging the pancreas itself or surrounding tissue. When these self-protective mechanisms break down for any reason, the result is leakage of enyzmes which damage the pancreas and any surrounding tissue they reach. This breakdown is called pancreatitis.
There are a number of things which can initiate or facilitate enzyme leakage, so pancreatitis can occur for a number or reasons. Often, it takes a combination of precipitating factors to cause pancreatitis to occur in a dog or cat. High fat diets, obesity and lack of exercise are the most common "life-style" contributors. Miniature schnauzers are predisposed to pancreatitis due to a tendency to have high levels of lipoproteins in their blood streams. Corticosteroids and azathioprine medications may contribute to the tendency to develop pancreatitis. Hyperadrenocorticism, a naturally occurring overproduction of corticosteriods that is fairly common in dogs may also lead to an increased susceptibility to pancreatitis. Anything that interferes with blood supply to the pancreas or release of digestive enzymes by the pancreas may lead to pancreatitis. For some reason, pancreatitis does not occur, or is not recognized, as often in cats as it does in dogs.
The "typical" pancreatitis patient is middle-aged or older and overweight. There may be a slightly higher prevalence of this problem in female dogs but it does occur commonly in both sexes. Often, the family has just had a party or a big holiday meal when this disease strikes. This is not a disease that restricts itself to any particular scenario, though. It often occurs in patients that do not fit the typical profile and it has highly variable clinical signs.
Any time a dog appears to be exhibiting signs of unexplained pain, pancreatitis must be considered. Vomiting is common with pancreatitis. Depression can be severe. Affected pets may seem restless or be reluctant to move, they may seem weak, irritable, have diarrhea or simply refuse to eat. Many owners recognize that their pet is very ill but may be baffled by a lack of symptoms to explain their pet's discomfort -- they just know they don't feel well.
When your vet examines your dog and suspects pancreatitis, she will look for abdominal pain that seems to be centered in the portion of the abdomen that is partially covered by the ribs. Dehydration is common in patients with pancreatitis. Rapid heartrate and rapid breathing are sometimes seen with pancreatitis. Poor circulation in capillaries may lead to redness of the gums and eye linings.
Confirming a diagnosis of pancreatitis can be frustrating. Currently, there is no single reliable diagnostic test for this disease. Often, amylase and lipase levels are elevated in the bloodstream. Unfortunately, this seems to happen slowly in comparison to the progress of the disease so a pet may be pretty ill before the enzyme levels elevate and in some cases of pancreatitis an elevation in these enzyme levels doesn't occur. Often, blood tests that help evaluate liver and kidney function are slightly elevated as well. White blood cell counts are usually high. Ultrasound exam of the pancreas, if your vet can do this, is helpful in diagnosis. X-rays are often taken to make sure other conditions are not causing the pain, such as intestinal obstruction, but usually it is not possible to be sure a dog has pancreatitis based on X-ray changes. Pancreatitis is harder to diagnose in cats because they are less likely to have high enzyme levels and either hide pain better or experience less pain, making the need for testing less obvious.
Pancreatitis can be acute and only occur once in a dog's lifetime or it can become chronic and keep returning over and over again. It can be a rapidly fatal illness or a mild attack of pain that resolves in a few hours or a day or so. It can cause tremendous side effects, including shock, blood clotting disorders, heart arrythmias, liver or kidney damage and death.
I think that chronic disease with varying levels of pain and secondary side effects is the most common form of pancreatitis. Fortunately, most of the time dogs with chronic pancreatitis problems do not die from the attacks. It is possible to lessen the severity and frequency of attacks in many of these dogs by managing their diet and exercise. Less commonly, pancreatitis strikes with a sudden severe fury that creates severe secondary problems, particularly with blood clotting and shock. In these cases, it can be fatal. It is not clear whether these are entirely separate disorders or different manifestations of the same problem. In cats, chronic pancreatitis is often associated with feline infectious peritonitis or toxoplasmosis and it may be beneficial to try to rule out these conditions if pancreatitis is suspected.
It is important to take pancreatitis attacks seriously, especially the first one. Pain management seems to help a great deal in preventing escalation pancreatic attacks, based on our clinical experience. Totally restricting food intake (no food) for 24 to 72 hours seems to help a great deal as well. This may be due to a decrease in stimulation of the pancreas to release digestive enzymes. Fluid therapy to prevent dehydration and help maintain circulatory function is usually necessary. Medications to control vomiting are often used. Many veterinarians use antibiotics in an effort to ward off secondary infections but this may not be necessary in milder cases as bacterial infections do not commonly accompany pancreatitis. Corticosteroids are not thought to be helpful in treatment of pancreatitis. It may be necessary to use intensive medical therapy for serious side effects of the disease or even surgical intervention in really severe cases of pancreatitis. In miniature schnauzers, medical control of the lipid levels may be beneficial and is sometimes possible using medications.
Once the patient seems to feel better, oral fluids are given. If no vomiting occurs in 12 to 24 hours, food can be offered in small quantities. Most pets can go home once they are willing to eat and drink again. Bland diets may be beneficial in some patients but we usually recommend returning to the patient's normal diet as long as it wasn't likely to be the cause of the problem due to fat content. Diets moderately high in fiber may be beneficial in lessening the number or severity of attacks in chronic pancreatitis. Weight loss and increasing exercise are also very likely to help prevent future attacks. Keeping your pet away from the table during traditional holiday meals can be very helpful, too.
It is very important to remember NOT to feed your dog when it is showing signs of abdominal discomfort or unexplained pain. It is almost painful to think of the number of times dog owners have said to me "she wouldn't eat, so I gave put a couple of tablespoons of bacon fat on her food...... or gave her a bowl of ice cream...... or a bowl of milk....... or a couple of pieces of ham....... " This is the worst thing you can do if your dog has pancreatitis. Learn to let them help themselves heal by not eating when their body is telling them it isn't a good idea! This can be the difference between a 24 hour attack of mild abdominal pain and 5 days in our hospital treating severe pancreatitis.
Mike Richards, DVM
Elevated lipase and amylase levels - Pancreatitis possible
Question: Dear Doctor,
Kenya, my ten-year-old spayed female chihuahua/dachshund/terrier mix,
has had some digestive problems. I would like your help with diagnosis
and treatment if possible:
Off and on over the last year, I have noticed a bit of mucus in her
stool. Someone had told me that an occasional appearance of mucus was
normal, so I didn't pursue it.
But about six weeks ago, I noticed a large quantity of mucus in the
stool. And I realized that she had been acting mildly uncomfortable with
increased frequency lately: Waking up at night, occasional grimacing and
tail down, etc. I thought it was due to pain in her spine area, which
has a history of disc problems and a discolysis three years ago---until I
noticed the increased mucus.
I had a blood test done and it detected a lipase level raised to about
593. All other levels apparently were normal. I took her off her usual
feed: Eagle brand dry with 1/4 cup of doggie stew (cooked veggies,
Lipiderm, garlic, brewers yeast, brown rice, tofu)and put her on white
rice, ground turkey and flax seed. The ultimate goal was to decrease fat
and simplify the diet.
It took over two weeks before her stool was free of mucus and had
returned to a firm consistency--it had gotten loose and yellow upon
eating the rice and turkey.
After 3 weeks her lipase went down to 519. The vet and I are
considering the possibility of:
pancreatitis, colitis, and/or inflammatory bowel disease. She has NOT been
vomiting to my knowledge. She was not having diarrhea, to my knowledge,
prior to the diet change. Now it isn't quite diarrhea, but it is very
loose and quite yellow.
The vet has mentioned an endoscopy or colonoscopy might be useful in
diagnosing IBD. What about an ultrasound to look at the pancreas?
If you have any ideas, insights, suggestions, I would be most appreciative.Answer: Thank you, Wendy-
Usually, it is best to evaluate the lipase and amylase levels in
conjunction with each other. If both amylase and lipase are elevated more
than 2 to 3 times the normal value, pancreatitis is very likely. Kidney
disease and pancreatitis are the two most common causes of elevations in
amylase and lipase. Pancreatitis will usually elevate the values more than
kidney disease will. There is a possibility of mild increases in lipase and
amylase due to intestinal disease or liver disease.It is important to compare the normal values for the laboratory running the
samples to the sample values in making determinations about rises in enzyme
levels, because lipase and amylase tests vary somewhat between labs. A
general average value for lipase would be 0 to 160 U/L , so the reported
values in the high 500s are above 3X the normal range, probably.An ultrasound exam might be very useful in making a diagnosis. There was a
recent report that ultrasonography was as good at identifying whether
inflammatory bowel disease was present as endoscopy. It would be a better
way of looking for pancreatitis. However, the advantage of endoscopy is
that it identifies the presence of IBD and also can allow a diagnosis of
the cause through biopsy of the intestinal lining in many cases.Low fat diets are generally beneficial when there is intestinal irritation
so that was a good thought.The best diagnostic technique for ruling in or ruling out chronic
pancreatitis is a pancreatic biopsy. Unfortunately, it is necessary to do
exploratory surgery to get pancreatic samples, so it generally makes more
sense to consider ultrasound exam and to check the lab work once a week for
two or three weeks prior to considering this, unless the patient seems to
be getting worse or if there is significant pain. Some vets are quicker to
go to surgery and there is some justification for this, since it takes a
few days to get biopsy results in most cases and they do help in planning
treatment options.One other thing you might consider, if the lipase continues to be the only
elevated value, is asking your vet to recheck the lab work through another
lab. Once in a while there are problems with a specific lab test at a lab
and it can take some time for the problem to be identified and
corrected. I'd especially consider this if Kenya continues to seem to be
OK, except for soft stools.Mike Richards, DVM
9/4/2000
Pancreatitis - feeding people food after bout
Question: Dr Richards:
I previously wrote to you about my dog and his
hip dysplasia and pancreitis. I was wondering,
since the vet told me NO MORE TABLE SCRAPS OR
FATTY FOOD(S), is there anything I can add to
their food to make it a little more palatable for
them? Broth? Rice? The gloucosimine tablets are
supposed to be flavored, but I have to wrap it in
Fat Free cheese. Is that ok?
I know they will live w/out people food, but man
are they spoiled........(yeah, I know ..I did
it!)
Answer: Michael-
I would not worry about a client using cheese or a small amount of peanut
butter or similar things to help with administration of medications even
after a bout of pancreatitis.I may not be the best source of information on this topic, though. I don't
even worry about clients giving dogs table scraps after the first bout of
pancreatitis. I just tell them to avoid very high fat and high salt treats
because they seem to cause problems, even though I can't find any real
evidence to support the high salt advice. It probably is better to feed pet
foods consistently after a second or third bout of pancreatitis (or maybe
even the first bout) but I think that having a little pleasure in life is
worth a small amount of risk. It will be easier for you on future office
visits if you follow your vet's advice though.Rice as a food additive is usually a safe choice. Broth is OK if it isn't
high in salt, so you shouldn't use bouillon cubes to make the broth unless
you use low salt ones. Just adding warm water to food makes it more
palatable for some dogs. Mixing a low fat canned food in with dry food is
often helpful in enticing reluctant dogs to eat, too.Good luck with this. Hopefully this will be an isolated incident.
Mike Richards, DVM
9/4/2000
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
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, DVMQuestion: 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
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
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
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 & SpankyA: 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
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
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
