Penny has pancreatitis. Again.

Poor Penny Lane. You and her are both in my thoughts and prayers. Hope she takes her meds like a good girl and that she is feeling much better soon.

I'm sorry to hear Penny's not feeling well.

Does she like bread? Otto will happily scarf down anything hidden in a piece of bread. And that might not upset her stomach very much.

In the past, I've used a piece of plain cooked pasta to put a pill in for Otto (a piece of ziti or a shell works well) and he'll eat that.

Hope she is feeling better very soon.

How about stinky liverwurst? They seem it like it and the smell helps cover up the meds?

My Bullmastiff got a very bad case of it once, but never had problems again. I will keep her in my prayers. I am sure it's harder on the seniors!

Dang, I hope Penny takes her meds and begins to feel better soon.

Well, things are looking up. She is taking her pills hidden in a bite of poached chicken chest. We are limited in what I can use to hide her pills, given her problems with wheat/corn/soy. I gave her a bit of the canned gi food this morning, and she did well, and even had an almost normal poop. Not back to her usual round/firm/fully packed, and still on the way there. At least it is not diarrhea.

Theresa, Dogtor Personality put her on Sucalfrate and Tramadol. Sneered when I suggested Flagyl/metronidazole. She was essentially NPO for two days, and is getting just small feedings today. I've got to get to the store for more chicken chest and some white rice.

After much thinking, I have decided to go to another vet practice. We have been going to the current one since she came home with me, and we had one dogtor for four years who loved Penny, and Penny loved her and we both trusted her. When she moved out of town, we switched to another who Penny liked, and she left shortly thereafter. Now there is only one vet there that I feel good about, and it would have to be life and death and no other dogtors in town before we see Dogtor Personality again. And this is the second most expensive vet practice in the area. So we are trying another practice that has gotten very good reviews and is very reasonably priced.

Renee, that article is very interesting and gives me much to think about. I knew that she would be prone to recurrance, and am just very grateful that this was nowhere near as bad as her first bout with pancreatitis. I thought we were going to have to burn the carpet in the living/dining room. I'm gonna check those enzymes out.

Thank you all for your good thoughts. I know that they have helped. I heart my pugfriends!

Nancy,

I am glad you are switching to a vet you feel better about. Nothing wrong with that at all.

I like to read Dr. Becker's articles because she has some fabulous information, but I tend to purchase any supplements from B-Naturals, the site by Lew Olsen. She has a digestive enzyme / probiotic blend that would probably do the trick for Miss Penny.

Good luck getting better!

Sulcralfate and Tramadol won't make her feel worse, but that's not okay that the vet attempted to make you feel stupid for suggesting a perfectly valid treatment, and for wanting to explore all of your options for Penny.

I will second the probiotic/enzyme supplements. I think the one I'm familiar with is sold through Purina. The main make up is usually the same, though. With my old roomie's dog, he either gets the supplementation daily or at the very least a week before anything stressful (long car ride, schedule change, new environment, etc) and then for a while after.

Glad Penny is more willing to take her meds. Leave it up to a pug to be on her own schedule with things. Give her a gentle hug for me. Reggie was on Tramadol after a rough dental with extractions, and that poor boy was feelin' so good and relaxed he forget to do the whole go pee thing for about 18 hours.

ETA: I'm glad you're looking for a new vet. It will be worth your peace of mind when you find one you trust.

I'm glad to hear Ms. Penny is feeling better and I totally agree with trying another vet.

We have an appointment with the new vet for Monday afternoon. I have enough Tramadol to last until then. It is making such a difference with Ms. Thang! Again, thank you all for your encouragement and good thoughts. And we are definitely getting the probiotic enzyme supplements. I really don't want to go through this again, and Penny definitely doesn't.

Canine Pancreatitis


Pancreatitis can be a serious acute condition, or just a chronic pain.



Your dog has vomited several times, doesn’t want to eat, and is
walking around with his back arched up, or lying in a corner refusing to
get up. Should you:

A) Try tempting him to eat by adding bacon grease to his food or offering something tasty like ham or bologna

B) Wait a day or two to see if he gets better

C) Take him to your vet right away

The answer is C: Take him to your vet right away. These can be signs
of pancreatitis. While it’s fine to wait to see if a dog improves on his
own after a single vomiting episode with no other signs of illness,
repeated vomiting can quickly lead to dangerous dehydration and
electrolyte imbalance, especially if your dog isn’t drinking or can’t
keep water down.

Pancreatitis can occur in dogs of any age, breed, or sex. That said, most dogs with pancreatitis are middle-aged or older, overweight, and relatively inactive.

When signs of abdominal pain accompany vomiting, pancreatitis is high
on the list of possible causes. The worst thing you can do is feed your
dog fatty food at this time.

Pancreatitis literally means inflammation of the pancreas, the
glandular organ that secretes enzymes needed to digest food. When
something causes these enzymes to be activated prematurely, they can
actually begin to digest the pancreas itself, resulting in pain and
inflammation.

Pancreatitis occurs in two different forms, acute and chronic, and
both may be either mild or severe. Acute pancreatitis occurs suddenly
and is more often severe, while chronic pancreatitis refers to an
ongoing inflammation that is usually less severe and may even be
subclinical (no recognizable symptoms).

Acute pancreatitis
Acute pancreatitis can be
extremely painful, and can become life-threatening if the inflammation
spreads, affecting multiple organs and systems. Symptoms commonly
include anorexia (loss of appetite), vomiting, weakness, depression, and
abdominal pain. Abdominal pain in a dog may be exhibited as
restlessness or not wanting to move; a hunched appearance or a “praying
position,” with the chest down and the rear raised; or vocalization
(crying or whimpering). Additional symptoms may include diarrhea,
drooling, fever, and collapse.

For mild cases, all that may be needed is to withhold food and water
for 24 to 48 hours (no longer), along with administering IV fluids to
prevent dehydration and drugs to stop vomiting and control pain.

For moderate to severe cases, hospitalization and intensive treatment
and monitoring is required. Supportive treatment includes intravenous
fluids to keep the dog hydrated and restore electrolyte and acid-base
balance. Potent pain medication is needed, such as injectable
buprenorphine or other narcotic pain relievers. Treatment is generally
required for three to five days, and sometimes longer. Surgery may be
necessary, particularly if the pancreas is abscessed or the pancreatic
duct is blocked.

Recommended medications that stop vomiting (antiemetics) in dogs with
pancreatitis include a metoclopramide infusion and chlorpromazine (once
dehydration has been controlled).

Alternatively, dolasetron (Anzemet) and ondansetron (Zofran) –
antiemetics developed to combat vomiting that has been induced by
chemotherapy – may be used. Cerenia (maropitant) is a new antiemetic
drug approved for dogs that some vets are starting to use, though it has
a limited track record. Metoclopramide (Reglan), a commonly used
antiemetic, may be contraindicated in pancreatitis due to concern that
it may decrease blood flow to the pancreas (antidopaminergic effect),
though this has not been substantiated.

Antibiotics to control infections secondary to pancreatitis may be
used, though this complication is not thought to be common in dogs. A
plasma transfusion is sometimes given in moderate to severe cases in the
hopes that it will inhibit active pancreatic enzymes and systemic
inflammatory response; it also provides clotting factors that can help
prevent and treat disseminated intravascular coagulation (DIC), an often
lethal potential side effect of pancreatitis.

Antacids have not been shown to have any beneficial effect in the
treatment of pancreatitis, though they may be given when vomiting is
persistent or severe. Non-steroidal anti-inflammatory drugs (NSAIDs) are
not effective and should be avoided due to concerns for gastric
ulceration and kidney and liver damage. There are no studies yet to
support the use of corticosteroids for treating pancreatitis in dogs.

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

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

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

Because most dogs with pancreatitis are unwilling to eat, a liquid
diet may be fed via a tube placed through the nose, esophagus, or
stomach. Dogs may tolerate nasoesophageal feeding even when vomiting
persists. There is evidence that pancreatic secretions are suppressed
during an attack of pancreatitis, so food delivered in this manner
stimulates the pancreas less than we used to believe, and helps to
maintain the health of the gastrointestinal tract and decrease
inflammation and side effects such as those listed above.

The ideal composition of this diet has not yet been determined. It is
possible that the addition of omega-3 fatty acids, pancreatic enzymes,
medium-chain triglycerides, and the amino acid l-glutamine to the liquid
nutrition may also help with recovery, though this must be done with
caution. Probiotics, however, are not recommended; a recent human study
showed an increased death rate for patients with severe acute
pancreatitis when probiotics were administered, possibly due to reduced
blood flow to the small intestine.

Enteral (tube or oral) feeding should begin after 48 hours without
food. Vomiting can be controlled with antiemetics and pain medication.
The goal of nutrition in the short term is to improve barrier function
(stop leaky gut syndrome) rather than to supply total caloric needs.

Parenteral (IV) nutrition should be used only when absolutely
necessary, due to persistent, uncontrolled vomiting. Survival rates
improve when it is combined with enteral nutrition. A tube can be placed
into the jejunum (part of the small intestine) if needed to provide
enteral nutrition when vomiting cannot be controlled.

Chronic pancreatitis
Chronic pancreatitis refers
to a continuing, smoldering, low-grade inflammation of the pancreas.
Symptoms such as vomiting and discomfort after eating may occur
intermittently, sometimes accompanied by depression, loss of appetite,
and weight loss. In some cases, signs may be as subtle and nonspecific
as a dog not wanting to play normally, being a picky eater, or skipping a
meal from time to time. Chronic pancreatitis may periodically flare up,
resulting in acute pancreatitis.

Dogs with chronic pancreatitis often respond favorably to a low-fat
diet. Pain medication can be helpful in relieving the symptoms of
chronic pancreatitis and may speed recovery.

Chronic pancreatitis is often subclinical and may be more common than
is generally realized, with symptoms blamed on other diseases. It may
also occur concurrently with conditions such as IBD (inflammatory bowel
disease) and diabetes mellitus.

Pancreatic functions In addition to digestive
enzymes (exocrine function), the pancreas also produces insulin
(endocrine function). Dogs who are diabetic may have an increased risk
for pancreatitis. Conversely, a dog whose pancreas is damaged due to
pancreatitis may develop diabetes, which can be either temporary or
permanent; 30 percent of diabetes in dogs may be due to damage from
chronic pancreatitis.

Exocrine pancreatic insufficiency (EPI), when the pancreas is no
longer able to produce digestive enzymes, can also result from chronic
pancreatitis, leading to weight loss despite consuming large amounts of
food. When the pancreas is damaged, diabetes is likely to show up
several months before EPI.

Causes of pancreatitis
Pancreatitis is often
blamed on high-fat diets, though there is little scientific evidence to
support this. Active, working dogs, such as sled dogs, can eat as much
as 60 percent fat in their diets without developing pancreatitis, but too much fat
may cause trouble for middle-aged, overweight, relatively inactive
dogs, who are the ones most commonly affected by pancreatitis. Too much
fat can also cause problems for some dogs with chronic pancreatitis.

Dietary indiscretion, such as eating rancid fatty
scraps from the garbage, can also lead to pancreatitis, particularly
when a dog accustomed to a low- or normal-fat diet ingests high-fat
foods. That’s why pancreatitis incidents are thought to increase after
Thanksgiving, when people may feed their dogs a meal of turkey skin and
drippings.

Low-protein diets have also been shown to predispose dogs to pancreatitis, especially when combined with high fat intake.
Some prescription diets may be a concern, such as those prescribed to
dissolve struvite bladder stones; to prevent calcium oxalate, urate, or
cystine stones; and to treat kidney disease; especially for breeds prone
to pancreatitis.

Several medications have been associated with pancreatitis, most recently the combination of potassium bromide and phenobarbital
used to control epilepsy. This combination has a much higher risk of
causing pancreatitis than phenobarbital alone (no studies have been done
on the use of potassium bromide by itself).

Many other medications have been linked to
pancreatitis, though the relationship is not always clear. These include
certain antibiotics (sulfa drugs, tetracycline, metronidazole,
nitrofurantoin); chemotherapy agents (azathioprine, L-asparaginase,
vinca alkaloids); diuretics (thiazides, furosemide); other antiepileptic
drugs (valproic acid, carbamazepine); hormones (estrogen); long-acting
antacids (cimetidine, ranitidine); Tylenol (acetaminophen); and aspirin
(salicylates).

Corticosteroids, such as prednisone, are especially controversial:
while veterinarians have long considered them to be the most common drug
to cause pancreatitis, recent human studies have discounted this link.
Based on anecdotal evidence, however, I believe the association does
exist in dogs. I personally know dogs who developed pancreatitis within
days of being given corticosteroids.

Toxins, particularly organophosphates (insecticides
used in some flea control products), as well as scorpion stings and
toxic levels of zinc, may also lead to pancreatitis.

Certain conditions may predispose a dog to pancreatitis. These include diabetes mellitus (though it is not clear whether pancreatitis precedes diabetes); acute hypercalcemia (high levels of calcium in the blood, usually from a calcium infusion or poisoning rather than diet or supplements); hyperlipidemia (high fat content in the blood, again usually due to metabolic disorder rather than diet); hypothyroidism; and Cushing’s disease (hyperadrenocorticism).

Both diabetes and hypothyroidism can affect fat metabolism and lead
to hyperlipidemia, which may predispose a dog to pancreatitis. Miniature
Schnauzers are prone to developing hyperlipidemia and thus may have an
increased risk of pancreatitis. Obesity predisposes dogs to
pancreatitis, and the disease is often more severe in dogs who are
overweight.

Pancreatitis can occur in dogs of any age, breed, or sex. That said,
most dogs with pancreatitis are middle-aged or older, overweight, and
relatively inactive. Cavalier King Charles Spaniels, Collies, and Boxers have been shown to have an increased relative risk of chronic pancreatitis, and Cocker Spaniels an increased relative risk of acute and chronic pancreatitis combined. Dachshunds have been reported to be predisposed to acute pancreatitis.

Other breeds mentioned as having an increased risk for pancreatitis
include the Briard, Shetland Sheepdog, Miniature Poodle, German Shepherd
Dog, terriers (especially Yorkies and Silkies), and other non-sporting
breeds.

People sometimes develop autoimmune chronic pancreatitis, and it is
theorized that dogs may as well. German Shepherd Dogs have been shown to
develop immune-mediated lymphocytic pancreatitis, which predisposes
them to pancreatic atrophy.

Pancreatitis has been associated with immune-mediated diseases, which
may include IBD, though the cause-and-effect relationship is not
understood. While there is no scientific evidence to support this, some
doctors have suggested that food allergies could be a rare cause of
recurrent or chronic pancreatitis. I think IBD could possibly be both a
cause and an effect of pancreatitis, or that both could be caused by an
underlying autoimmune disease or food allergy.

Dogs with immune-mediated pancreatitis may respond well to
corticosteroids such as prednisone, which suppress the immune system,
even though this drug has also been thought to cause acute pancreatitis.

Trauma to the pancreas, such as a result of the dog being hit by a car, can lead to inflammation and pancreatitis. Surgery
has also been linked to pancreatitis, probably due to low blood
pressure or low blood volume caused by anesthesia. Gallstones
(choleliths) can block the bile duct, and thus the flow of digestive
enzymes from the pancreas and can lead to pancreatitis in people; it is
likely that the same would be true for both species (pancreatitis can
also block the flow of bile from the gall bladder).

Other theoretical causes include bacterial or viral infections;
vaccinations; obstruction of the pancreatic duct; reflux of intestinal
contents up the pancreatic duct; impaired blood supply to the pancreas
due to shock, gastric-dilatation volvulus (bloat), or other causes; and
hereditary factors. In rare cases, pancreatitis can be caused by a tumor
in the pancreas.

In most cases with dogs, the cause is never found. In people, pancreatitis is most commonly caused by alcohol abuse.

Confirming the diagnosis
Some blood test results
are suggestive of pancreatitis, but not definitive. Substantially
elevated (three to five times the normal level) lipase and amylase, in
particular, are strongly supportive of a diagnosis of pancreatitis, but
the absence of these signs does not rule it out; lipase and amylase may
be normal in as many as half of all dogs with pancreatitis. With chronic
pancreatitis, blood tests are often completely normal, and may be so
with acute pancreatitis as well, particularly if it is not severe enough
to cause complications.

In 2005, IDEXX Reference Laboratories developed a blood test called
Spec cPL (canine pancreas-specific lipase), based on the cPLI (canine
pancreatic lipase immunoreactivity) test developed at Texas A&M
University. There are three types of lipase: pancreatic, hepatic, and
gastric. Standard blood tests cannot differentiate between them, but the
Spec cPL measures only pancreatic lipase. Spec cPL is now considered
the best choice for quick and accurate diagnosis, with results available
in 12 to 24 hours. The cPLI test is equally accurate, but not as
readily available and the results take longer.

IDEXX claims that the Spec cPL test has a sensitivity greater than 95
percent, meaning almost every dog with pancreatitis will test positive
(fewer than 5 percent false negatives), and a specificity also greater
than 95 percent, meaning fewer than 5 percent of dogs who don’t have
pancreatitis will have a false positive result. In comparison, the cPLI
test has 82 percent sensitivity and 98 percent specificity.

The Spec cPL test can be repeated every two or three days to help
judge response to therapy, and after returning home, to confirm
recovery. It can also be used to monitor response to changes in diet and
other treatment for dogs with chronic pancreatitis.

The Spec cPL test is recommended for any dog whose symptoms include
vomiting, anorexia, or abdominal pain. It can also be used to monitor
dogs with chronic pancreatitis, or those with conditions or whose
medications predispose them to pancreatitis. In the future, this test
may be done as part of standard blood work on normal, seemingly healthy
dogs, to identify chronic pancreatitis that may be subclinical (not
causing recognizable symptoms).

In 2007, IDEXX introduced the SNAP cPL, a version of the Spec cPL
test that can be done in-house by your veterinarian and return results
in 10 minutes. If the SNAP cPL test results are abnormal, IDEXX
recommends that you follow up with a Spec cPL test to establish a
baseline cPL concentration and to monitor treatment.

Radiographs detect only 24 to 33 percent of cases of acute
pancreatitis, but are also used to identify other causes of vomiting and
anorexia, such as intestinal obstruction.

An experienced ultrasound practitioner can detect two-thirds of acute
pancreatitis cases. Ultrasound may also be used to look for signs of
peritonitis, pancreatic abscess or cyst, and biliary obstruction.
Neither x-rays nor ultrasound can identify chronic pancreatitis. Biopsy
of the pancreas can be used to identify pancreatic cancer. Biopsy may be
an unreliable method of diagnosing pancreatitis, as often only part of
the pancreas is affected.

TLI (trypsin-like immunoreactivity) is a blood test that has only 33
percent sensitivity for pancreatitis, but it is very accurate for
diagnosing EPI (exocrine pancreatic insufficiency). Dogs with chronic
gastrointestinal problems should have TLI, cobalamin, folate and Spec
cPL testing done to look for EPI, SIBO (small intestine bacterial
overgrowth, also called ARD, or antibiotic-responsive diarrhea), and
chronic pancreatitis. Dogs with EPI usually have lower-than-normal Spec
cPL results, but TLI is considered more accurate for diagnosing EPI.

Some breeds are at increased risk of developing ancreatitis. Miniature Schnauzers are prone to yperlipidemia, which in turn can be a cause of pancreatitis.

Recovering from acute pancreatitis
Whether in the
hospital or at home, once vomiting is under control, water is slowly
introduced, with a few laps or ice cubes every hour or so. If the dog
keeps this down, liquids are tried next, followed by soupy, low-fat,
high-carbohydrate foods. Frequent small amounts are less likely to cause
problems than larger quantities, particularly in the beginning. Dogs
who have been hospitalized can return home once they are able to keep
food down without vomiting.

Dogs are often sent home with pain medication, such as a Fentanyl
patch or Tramadol. Controlling pain is important during recovery, so ask
your vet for help if you feel your dog is uncomfortable.

Dogs recovering from acute pancreatitis are frequently maintained on
an easily digestible, fat-restricted prescription diet, particularly if
they are overweight or have hyperlipidemia. While I am not a fan of
these products due to their low-quality ingredients, I think that
sometimes it is easier to follow your vet’s advice, as long as your dog
is willing to eat this food and does not react adversely to it. You can
later transition your dog back to a better quality commercial or
homemade diet.

But what if your dog won’t eat the prescription food, or reacts
poorly to the food, or you just can’t bring yourself to feed a
commercial food after feeding a homemade diet for so long? What should
you feed your dog in that case?

What to feed in the beginning
The goal in the
beginning is to feed a diet with low fat, moderate protein, and high
carbohydrates, as carbs cause the least amount of pancreatic
stimulation. An easy diet to start with is overcooked white rice made
with extra water, combined with a low-fat protein source, such as cooked
chicken breast, low-fat cottage cheese, or boiled hamburger (boiling
removes most of the fat).

Even if you normally feed a raw diet, the meat should be cooked for
now, to remove fat and to destroy bacteria that can be problematic if
the intestines have been damaged. Cooking or warming food usually makes
it more appealing as well. Bones should not be fed at this time. Offer
food at room or body temperature, as cold food takes longer to digest.

If possible, choose foods your dog has had before – ones you know
agree with him and that he likes. White rice is the preferred
carbohydrate choice, as it is easiest to digest, but you could use
potatoes or sweet potatoes instead if you need to avoid rice due to
allergies or intolerance (remove the skins to reduce fiber in the
beginning).

Overcooking starchy foods such as rice or potatoes increases their
digestibility. Cooking white rice with extra water creates a type of
porridge called rice congee, which is soothing to the stomach and
digestive tract, and can help relieve vomiting and diarrhea. To make
congee, boil one cup of white rice (not Minute Rice) in four cups of
water for 20 to 30 minutes. You can offer the rice congee liquid alone
to start with, then include the rice, and next add the protein. This
progression can happen over the course of a few hours or a day or two.

At first, feed a higher percentage of carbohydrates, and a lower
percentage of protein, such as two-thirds carbs and one-third protein.
If your dog is doing fine, the ratio can then be slowly changed to half
and half after the first few days.

Whatever you feed, start with small amounts fed frequently, six to
eight meals a day or more. Small meals stimulate the pancreas less, and
are less likely to trigger vomiting. Small meals are also easier to
digest than larger meals, and less likely to cause discomfort. If your
dog is able to keep the food down without vomiting or showing signs of
pain, you can begin to feed larger amounts at longer intervals, but
proceed slowly, especially in the beginning; you don’t want to make
changes too quickly and end up with a setback.

Contact your vet for advice if your dog vomits. You will probably
need to stop feeding again briefly (12 to 24 hours), then start over by
introducing water and progressing to bland foods again. Your dog may
also need anti-vomiting medication.

It is not necessary for your dog’s diet to be “complete and balanced”
in the short term; an adult dog will do fine on an incomplete diet for a
few days to a few weeks. Start with a very simple diet, and then add
more ingredients as your dog recovers and you see he is doing well.

Broth and other flavorings
Broth can be used to
make rice and to add to foods to improve flavor and encourage your dog
to drink more. Many store-bought broths are high in sodium, however;
even some “reduced sodium” varieties have hundreds of mg per serving.
Look for broths with less than 100 mg sodium per serving. You can make
your own nonfat, no-sodium broth if you prefer.

You can also use the water that you boil chicken or other foods in
for flavor and nutritional value, since boiling removes some nutrients
that are then left in the water. Just be sure to remove the fat before
feeding.

Healing the digestive tract
L-glutamine is an
amino acid that can help the intestinal mucosa to recover from the
effects of going without food. A typical dose is 500 mg per 25 lbs of
body weight daily, but 10 times that much can be used to supply
nutrition when necessary.

L-glutamine is available both as a powder and in capsules. The powder
can be dissolved in water or mixed in food. Glutamine is unstable at
room temperature for extended periods, so any uneaten portion should be
removed after 15 minutes. L-glutamine can be found at supplement shops
online and at health food stores.

Seacure is a highly nutritious supplement designed to treat
malnutrition. Seacure can help to heal the intestines and provide other
health benefits. Made of hydrolyzed whitefish, Seacure has a fishy
smell. Sprinkled on your dog’s food, it helps make the food more
attractive to your dog. (See “Securing Seacure,” WDJ April 2003, for
more information.)

The herbs slippery elm and marshmallow can help to soothe a throat
and stomach that have been irritated by vomiting. One product that
contains both is Phytomucil from Animals’ Apawthecary. You can also make
your own by steeping 1 teaspoon of either or both dried herbs in 8
ounces of very hot water. Optionally, add a teaspoon of honey for
flavor. Give from 1 teaspoon to 4 tablespoons, depending on the size of
the dog, every four hours.

Transitioning to a normal diet
Once a dog has had
an attack of acute pancreatitis, he may be less able to tolerate fat in
the future, depending on how much the pancreas was damaged. Some dogs
are able to return to a normal diet after they have fully recovered,
while others may need a low-fat diet for the rest of their lives to
prevent chronic pancreatitis and further acute episodes.

Dogs who experience a single, acute, uncomplicated episode are more
likely to be able to return to a normal diet, while dogs with repeated
episodes of acute pancreatitis, hyperlipidemia, or steatorrhea (large,
greasy, foul-smelling stools caused by fat malabsorption) should be kept
on a fat-restricted diet.

Dogs with chronic pancreatitis may also do better on a lower-fat
diet. Drugs that predispose dogs to pancreatitis should be avoided if
possible in these dogs. If such drugs are needed, e.g., to control
seizures, these dogs, too, may benefit from a low-fat diet. Dogs who
have had acute pancreatitis should never be fed really high-fat meals,
even if they are able to return to a normal diet afterwards.

Continue to feed a low-fat diet with moderate protein for at least 7
to 10 days or longer, depending on the speed of your dog’s recovery and
the severity of the episode. Gradually increase the size of each meal
and the time between meals until your dog is eating two or three meals a
day.

If your dog is doing well and showing no sign of discomfort after
eating, you can then begin to gradually increase the amount of fat in
the diet. Begin adding small amounts of his regular food back into his
diet. If the diet he was eating before was high in fat, try feeding
foods with a moderate amount of fat to start with, though you may
eventually be able to transition back to somewhat higher-fat foods if
your dog gets a lot of exercise, is lean rather than overweight, and you
have reason to believe that something other than diet caused the acute
pancreatitis.

Remember that lower-fat diets provide fewer calories, so the total
amount you feed will need to be increased when you reduce the amount of
fat in the diet. The increase will depend on how much fat was in your
dog’s previous diet. If possible, determine how many calories your dog
was getting before and try to match that with the new diet (or
moderately decrease the calories, if your dog is overweight). Weigh your
dog frequently and then adjust the amount you are feeding up or down as
needed to maintain proper weight. If your dog lost weight due to acute
pancreatitis, don’t try to put the pounds back on too quickly; slow and
gradual weight gain or loss is healthier than trying to make large
changes in a short period of time.

Keep a close eye on your dog, particularly after meals, watching for
signs of discomfort such as a hunched appearance, whining, panting,
restlessness, or not wanting to move around. If you see any of these
signs, return to a lower-fat diet and smaller, more frequent meals, and
wait longer before trying again to increase the amount of fat even more
slowly, using different foods. If the signs of discomfort return, you
may need to keep your dog on the lower-fat diet indefinitely.

Also watch for signs of digestive upset, such as burping or
flatulence (gas), borborygmus (stomach gurgling), lip licking, or heavy
swallowing. These are not signs of pancreatitis, but could indicate that
the diet you’re feeding does not agree with your dog. Try feeding a
different brand of food, using different ingredients, a grain-free diet,
or one with a different protein source, adding digestive enzymes, or
feeding smaller, more frequent meals, to see if that helps.

These symptoms can also be signs of EPI, especially if accompanied by
increased appetite, weight loss, and large “cow-patty” stools. EPI is
treated with prescription-strength digestive enzymes such as Viokase,
Pancrezyme, or generic equivalents. Raw pancreas can also be used, or
human pancreatin supplements, which consist of freeze-dried pork
pancreas.

With pancreatin supplements, strengths such as 4x or 10x indicate
that the product is concentrated and the dosage is equivalent to 4 or 10
times as much as is shown on the label. Each mg of pancreatin contains
25 USP units of protease and amylase, and 2 USP units of lipase. Dogs
with EPI may also require cobalamin (vitamin B12) injections, and often a
low-fat diet as well.

Preventing recurrence
Pancreatitis is both more
common and more severe in overweight dogs. Inactivity may also be a
contributor, so weight loss and exercise are both important.

Many weight loss diets are extremely high in carbohydrates, with low
fat and low protein – in fact, some have even less fat than the
prescription diets that are recommended for dogs recovering from
pancreatitis. A low-fat diet is not required for dogs to lose weight,
and higher protein helps dogs lose fat, while low protein can lead to
muscle loss. It’s better to feed a diet that has higher protein and
moderate amounts of fat and carbohydrates to help your dog lose weight.
(See “Diet and the Older Dog,” December 2006, for more information on
this topic.)

Underlying metabolic disease such as hypothyroidism,
hyperadrenocorticism (Cushing’s disease), and diabetes mellitus may be
associated with increased risk of pancreatitis and should be managed
appropriately. Hypothyroidism can contribute to obesity and may affect
fat metabolism. Not all dogs who are hypothyroid have the classic signs,
such as dry skin and hair loss. A full thyroid panel is more accurate
than a simple screening test. Even dogs whose results are in the low
normal range may benefit from thyroid supplementation. Noted thyroid
specialist Dr. Jean Dodds at Hemopet will consult with you or your vet
regarding test results for a small fee.

If your dog is prone to hyperlipidemia (increased blood levels of
cholesterol or triglycerides, even when fasted for 12 hours before the
test), there are several things you can do to try to lower these levels
and reduce the likelihood of pancreatitis. Feeding a low-fat diet,
giving fish oil supplements, and treating hypothyroidism, which is often
the underlying cause, are all helpful in reducing lipid levels in the
blood. In addition, dogs prone to hyperlipidemia may benefit from the
use of human statin medications, such as Lipitor, to control lipid
levels. Though no studies have yet been done, anecdotal reports from
vets who have tried this on an experimental basis have been positive.

Whether or not too much fat was the initial cause of your dog’s
pancreatitis, high-fat foods may trigger a recurrence, particularly if
the pancreas was damaged. Be sure that your dog does not have access to
your trash bin (use locking lids or an alarm if needed), and don’t feed
high-fat foods or treats such as pig ears. Make sure that your dog does
not get fatty treats from other family members, friends, or neighbors.
Don’t try to tempt your dog with high-fat foods and additives if he
doesn’t want to eat; this may be good advice even for dogs who have not
had pancreatitis, unless you’re certain that the inappetence is not
caused by pancreatitis nor a condition that would predispose a dog to
it.

Avoid medications that may be linked to pancreatitis, particularly
any that may have contributed to the initial attack. If possible, find
alternative therapies for dogs taking drugs known to cause pancreatitis,
such as using Keppra (levetiracetam) in place of or in combination with
potassium bromide or phenobarbital for seizures.

In people, vaccinations have sometimes been associated with
pancreatitis. Avoid overvaccinating your dog. The American Animal
Hospital Association now acknowledges that there is no need for yearly
“boosters” for most vaccines. (See “Vaccinations 101,” August 2008, for
more information on current vaccination recommendations.)

Periodic monitoring with the Spec cPL test may be helpful in
preventing recurrent pancreatitis, especially after a change in diet.

Supplements
Certain supplements can help reduce the risk of acute pancreatitis or control the effects of chronic pancreatitis.

Digestive enzyme supplements that contain pancreatin may be helpful
for dogs who have had acute pancreatitis or suffer from chronic
pancreatitis. It is theorized that these may reduce the load on the
pancreas and inhibit pancreatic secretion.

These supplements are sold over-the-counter for humans or dogs; the
prescription-strength enzymes needed by dogs with EPI can also be tried
to see if they seem to reduce pain from chronic pancreatitis. Note that
enzymes seem to help some dogs, but not others. If your dog does not
respond well to one brand, you can try adjusting the dosage or using a
different brand, but don’t continue to give them if they cause any
problems.

You can also try feeding small amounts of raw pancreas, giving
pancreatic glandular supplements, such as Pancreatrophin from Standard
Process, or giving plant-derived digestive enzymes, which may be helpful
if your dog has trouble digesting carbohydrates.

Fish body oil, such as salmon oil or EPA oil (not cod liver oil), can
help to lower blood lipid levels (both triglycerides and cholesterol)
in dogs with hyperlipidemia. Studies have also found it to be beneficial
in treating acute pancreatitis, while its effects on chronic
pancreatitis are unknown. The dosage needed to treat hyperlipidemia may
be as high as 1,000 mg of fish oil (supplying 300 mg combined EPA and
DHA) per 10 lbs of body weight. Dogs with normal lipid levels should do
fine on that amount per 20 to 30 lbs of body weight daily, preferably
split into two doses. If you use a supplement with more or less EPA and
DHA, adjust the dosage accordingly. Vitamin E should always be given
whenever you supplement with oils – give around 5 to 10 IUs per pound of
body weight daily.

Probiotics are beneficial bacteria that live in the intestines and
help to keep bad bacteria in check. While probiotics are not recommended
for dogs with acute pancreatitis, their effect on chronic pancreatitis
is unknown. As they are known to help with some gastrointestinal
problems, and since their population may be depleted during acute
pancreatitis, I think it makes sense to give them once your dog has
recovered. You can use products made either for dogs or for people.

Prebiotics are indigestible carbohydrates that feed the beneficial
bacteria in the intestines and are often included in probiotic
supplements. Certain prebiotics called oligosaccharides have been shown
to decrease triglyceride and cholesterol blood levels, which can be
helpful for dogs prone to hyperlipidemia. These ingredients may be
listed on the label as fructooligosaccharides (FOS), oligofructose,
inulin, or chicory. (See “Probing Probiotics,” August 2006, for more
information on both probiotics and prebiotics.)

Dogs fed a very low-fat diet may become deficient in the fat-soluble
vitamins A and E. Adding fish oil and coconut oil to the diet can help
with this. Dogs with damage to the pancreas may also suffer from vitamin
B12 (cobalamin) deficiency – in this case, monthly injections may be
needed if the dog is unable to absorb B12 when given orally. Chronic
pancreatitis may interfere with absorption of vitamin B, so
supplementing with B-complex vitamins makes sense.

Human studies suggest that antioxidants, which are found mostly in
fruits and vegetables, may help protect against pancreatitis, and reduce
the pain of chronic pancreatitis. Vitamin E and selenium (which work
synergistically), vitamin C, beta-carotene, and methionine have been
found to be effective in helping to prevent pancreatitis in human
studies.

Other natural antioxidants sometimes recommended for chronic
pancreatitis, though evidence is lacking, include SAM-e (S-adenosyl
methionine); alpha lipoic acid (not recommended for diabetics); OPCs,
found in grapeseed extract and pycnogenol; resveratrol; and milk
thistle. There are a number of combination antioxidant products made for
dogs, such as Small Animal Antioxidants and Immugen from Thorne
Veterinary, and Cell Advance made by Vetri-Science.

In their book, All You Ever Wanted to Know About Herbs for Pets,
Greg Tilford and Mary Wulff-Tilford suggest herbs to support the liver
and digestive system. “Dandelion, burdock root, or Oregon grape can help
improve digestion and reduce pancreatic stress by gently increasing
bile and enzymatic production in the liver.

...Yarrow is said to help reduce pancreatic inflammation and improve blood circulation to the organ.”

Long-term low-fat diets
Next month, we will
discuss commercial and homemade diets for dogs with chronic
pancreatitis, EPI, and other conditions that may require a low-fat diet
to be fed long-term. You will learn what defines a low-fat diet, and how
to calculate the amount of fat in any food or combination of foods,
whether kibble, canned, dehydrated, frozen, or fresh. The following
month, we will present actual low-fat diets that people are feeding to
their dogs.

For a list of scientific references for the material in this article, send a request to Mary Straus at WDJ@dogaware.com.

Mary Straus researches canine health and nutrition topics as an
avocation. She is the owner of the DogAware.com website. She lives in
the San Francisco Bay Area with her 16½-year-old dog, Piglet.

Thank you, Blanche. You are the best. The dietary advice is pretty much what I am doing, although I will water the rice down a bit more. She's getting about 2/3 rice and 1/3 chicken. We see the new dogtor on Monday, and I'm going to check out the probiotics and enzymes. Plus add some salmon oil back into her diet.

Continued good thoughts for Miss Penny Lane.