"Then she and our other dog, Zoie, had a horrific fight over a dog treat." Both dogs needed surgery and sutures to close their wounds. She suspected
Emma's behavior problems had its origins in a thyroid problem. While at the veterinarian's office Heidi insisted Emma be tested for chemical imbalance. Blood was drawn; sent to the lab and came back negative. "But her pancreatic
enzymes were elevated. The diagnosis was pancreatitis. We were told that it could be caused from adding fatty foods to her diet."
"He told us that pancreatitis attacks can be very painful and I thought this could be the reason
for her moodiness and aggression," says Holmes. "What dog wouldn't react to pain."
What it is
A glandular organ located near the liver and duodenum, the pancreas performs two different types of glandular functions. The
first endocrine function is to produce insulin, an important hormone in the control of metabolism and blood sugar levels. Secondly, the pancreas has an glandular function, to make digestive enzymes (chemicals that break down food
for digestion) that secrete into the intestines, critical for normal food digestion.
When the pancreas is injured either from disease or from trauma, the production of digestive enzymes decreases, or the enzymes may actually
start to digest surrounding organs including the pancreas itself.
"This disease mimics and can be mimicked by almost any acute gastrointestinal disorder as well as a variety of extra-intestinal diseases," says Colin Burrows,
BVetMed, Ph.D, MRCVS, professor of medicine, University of Florida, Gainsville, Florida. "Severe cases are routinely included in the differential diagnosis." The most common ones are 1) acute gastroenteritis; 2) exacerbations of
inflammatory bowel disease; 3) intestinal obstruction; 4) peritonitis; and 5) acute renal failure.
Pancreatitis is the disorder that happens when the pancreas becomes inflamed. There are two classification of the disease, chronic
and acute.
"Basically, there are differences between chronic and acute," says Dr. Jorg Steiner, DVM, DACZIM, DECZIM, Gastrointestinal Laboratory Professor, Texas A&M, College Station, TX. "The most important, when acute
pancreatitis is over, there is no remaining damage to organs. Acute is more commonly severe, and chronic is more commonly mild."
"Pancreatitis can be very serious," says Dr. Mary Labato, DVM, internal medicine, Tufts University
School of Veterinary Medicine, North Grafton, MA. "It can run the gamut from mild with vomiting to life threatening and the cause of rapid death."
"Acute pancreatitis is the inflammation of the pancreas that occurs abruptly with
little or no permanent pathologic change," say Dr. Labato. "Acute necrotizing pancreatitis is a life threatening disease that can lead to acute renal failure, pleural effusion, and death. Chronic pancreatitis is a continuing
inflammatory disease that is often accompanied by irreversible changes."
Heeding the Warning Signs
Holmes says her veterinarian gave them a container of powdered enzymes to add to Emma's food. She loved it and
began eating her usual amount with no problems. "Emma was more like the dog we knew before playful, wanting to snuggle, and always greeting us at the door with a toy in her mouth."
As the powdered enzymes came with few
instructions, Holmes says she called the veterinarian to see how long she should continue using them "I was told to give them when her symptoms of diarrhea, vomiting and lethargy were present and to cease them when she was feeling
better."
Holmes felt unsure and became less confident in her veterinarian. "I thought the vet would monitor her pancreatic function through blood tests."
"Finally, we switched to a new veterinarian who looked at the bloodwork
from Emma's first test and ran a second one. Her pancreatic enzymes were even more elevated than the first test."
The veterinarian calls Holmes periodically to check on Emma's condition and suggested another blood study be
conducted in a few weeks.
"He gave us a referral to see a veterinary behaviorist for Emma's aggression. She was fine until several months ago and then it was like a switch went on at just about the same time she developed this
pancreatic problem."
Within a four-month period, Emma had several suspicious symptoms that concerned her owners. Her appetite became irregular, says Holmes, "Some days she would be so hungry that she ate everything she could and
others she wouldn't eat at all."
Before Emma was diagnosed Holmes says when Emma refused to eat she'd put chicken broth on her dry food, which Emma ate. After that, the dog received various toppings to supplement her regular food
including leftovers, milk, and cheese.
"Now I know that fatty foods can aggravate an existing pancreatic problem," says Holmes. "I feel a tremendous amount of guilt for contributing to her problem. I just thought she was
spoiled."
In the clinic at Texas A&M, Dr. Steiner says, "Dogs with pancreatitis present with vomiting and abdominal pain," says Dr. Steiner. "They appear uncomfortable, sensitive to touch, and may vocalize."
Dr. Steiner noted that 1.5% of all dogs have pancreatitis and slightly more than 90% of dogs, cats, and humans have pancreatitis without being diagnosed with the condition. "In the United States alone, there are 300,000 hospital
discharges for people with pancreatitis."
Cause and Treatment
In a large number of cases, according to Dr. Steiner, the cause of pancreatitis remains unknown. During holiday seasons, especially Christmas and
Thanksgiving, Dr. Steiner says he sees many more cases of pancreatitis at the clinic due to high fatty meals. Another cause of pancreatitis is brought on by medication including the medications asparagines and eazathioprine.
Under normal conditions, digestive enzymes produced by the pancreas are activated when they reach the small intestines. In pancreatitis, these enzymes activate prematurely in the pancreas instead of in the small intestines. The
intensity of the disease will depend on the quantity of enzymes that get prematurely activated.
Dr. Steiner says, "The physical exam, history of vomiting and abdominal ultra-sound is very good at diagnosing pancreatititis but may
not rule out having the disease."
Dogs with pancreatitis are usually unable to keep down medications or food given by mouth. Consequently, hospitalization and the use of injectable medications and fluids are necessary.
Typical
medications administered for this disease are antiemetics, analgesics, and antibiotics. It is important to completely fast the dog and give nothing by mouth (NPO) for at least 24 to 48 hours.
"There's a new serum test called
canine pancreatitis lipase immuninol reactivity that is about 82% sensitive," says Dr. Steinter. "There are other tests being used but they are not as good."
Other diagnostic tools, according to Dr. Labato, include the following:
CBC (complete blood count) profile, lipase and amylase, TLI (increased in acute pancreatitis), ElISA for TAP (trypsinogen activation peptide), abdominal ultrasound, diagnostic peritoneal lavage, and a CAT scan.
Ultrasound is
also being used with increased frequency in veterinary practices to support the diagnosis of pancreatitis. "Unlike x-rays, which give only a general impression, ultrasound allows a thorough examination of the whole organ. It is
important to note, however, that a normal appearing pancreas on ultrasound makes the diagnosis of pancreatitis less likely but most certainly does not eliminate it," says Dr. Burrows.
Often times, a prescription diet is
required, either for a particular time period or for the life of the dog. Keep in mind that feeding table scraps to dogs with a predisposition for this condition is harmful to your dog.
With this disease, avoid high protein and
high fat diets. "Feed small frequent feedings of a bland diet," says Dr. Labato.
Dogs at Risk
As with most diseases or conditions, certain dog breeds are more susceptible than others. Schnauzers seem to win the award
for coming down with this disease more often than any other breed. "It appears there's a genetic susceptibly to the disease," says Dr. Steiner."
According to Dr. Labato, "Dogs are vulnerable at any age, but more commonly in
middle age (seven years) and older. And, female dogs seem to be more regularly represented."
Dogs that are more predisposed to this condition are the following: miniature Schnauzers, Yorkshire and Silky Terriers, miniature
poodles and cocker spaniels.
A direct risk factor aside from breed, size, weight, age, and gender are dogs with diabetes. "Dogs with diabetes that develop pancreatitis are difficult to treat," says Dr. Labato. "Their blood sugars
may become very high."
Because the dog is not eating and is vomiting, it becomes very difficult to administer insulin. If insulin is given, the blood sugars will require close monitoring as the dog may become hypoglycemic. In
addition, diabetes may result as a complication of a severe case of pancreatitis.
What's a Dog Owner to do
Pancreatitis can be a very unpredictable disease. In most cases, if the attack was mild and the dog only had one
episode, chances of recovery are good. Simply avoiding high fat foods may be all that is called for to prevent recurrence and/or complications.
"The recovery rate really depends on the degree of severity of the attack," says
Dr. Steiner. "In mild forms it is 100% recovery and in severe forms it is 50%."
Dr. Labato states the recovery rate with acute necrotizing pancreatitis is guarded to poor.
In the meantime, Holmes continues to watch and wait
for further information about Emma. "We're still watching our snuggle-bug, waiting for answers. This whole process has cost us a fortune but if we can find a cure, it will be well worth it. It pains me to see her so uncomfortable."
Here is the good news; most dogs with uncomplicated pancreatitis (no additional health problems) recover spontaneously after a single episode. These dogs typically do well when diets don't include foods high in fat content.
