UPDATE on Abbie's Pancreatitis-back from vet again
 

Well, we are back from another vet visit. Abbie appeared to being doing well up until yesterday afternoon when she vomitted 2X. No other symptoms all day so I backed off of the food (chicken and rice) a little and continued with water. She woke up at 4 AM this morning with another episode of vomitting. Called ER vet who suggested that we take her to regular vet at 8AM.

I decided to take her to a different vet this time because while I liked the fact that the prior vet had the SNAP cPL, I did not like that she encouraged the bland diet (saying it was based on new research) without NPO status for 24 hours. On Friday I also asked her about Cerenia (I have it here at home) and she said, "No, don't give that to her. Just give her bland food."

Today I showed the photos of the poo, described her waxing and waning episodes of vomitting (no poo since Sunday AM), and had all of her blood work faxed to the new vet. Vet says does appear to be pancreatitis but also based on the photos of the poo she dx her with HGE. This vet had a wonderful bedside manner and took her time to describe a complete plan of care (plan of attack is more how I look at it :))

Abbie received subcut Lacated Ringers, a shot of Cerenia, and Clavamox. She is NPO for the next 24 hours. Vet also suggested FortiFlora for when she is eating again so we bought a box of that as well.

Thanks for all prayers and education about this horrible condition. Will keep you updated.

It sounds like the new vet will get Abbie better. Hope she is better soon.

Wishing Abbie well with this new vet. Hope he/she can make him well.

Wow...this vet said it is HGE and did not think she should be on iv fluids?

Here is a link with information:

HGE: Hemorrhagic Gastroenteritis in Dogs Explained

Hope she is better soon. :)

GLAD you found a vet that knows a bit more, hope she feels better soon.
hugs,
Carmen in nj:)

Did the new vet do bloodwork today? HGE is diagnosed when the packed cell volume is over 60.

HGE also has the characteristic raspberry jam diarrhea as they are literally hemorrhaging. You said Abbie hadn't pooped since Sunday? :confused:

Lady has had HGE three times. It has always been an emergency situation, one that can be fatal if not treated immediately. Supportive care, mainly IV fluids, is the standard treatment.

Hemorrhagic Gastroenteritis (HGE)

I'm frankly confused how a vet could make a diagnosis of HGE with only a picture of diarrhea that had subsided and three day old bloodwork. :confused::confused:

Just to correct my previous statement, I double checked and the cut off for HGE is a PCV of over 55, not 60.

Did you get a copy of Abbie's bloodwork? Look under the hematology results. The packed cell volume is under HCT (hemocrit).

A typical blood chemistry panel usually includes

The other vet did a CBC ... .. ?

Turn for the worse
 

Sorry it took so long to reply. I'm mentally and physically drained at this point. The new vet made the HGE dx based on her PRIOR CBC (from Friday) and the photos. She said it "looked like HGE at that time but it seems to be clearing up since she hasn't pooped since Sunday" hence the need for only subcut fluids.

However after taking a nap today Abbie started acting very strange and just not herself. She was acting like she was in pain and shaking. I immediately called the vet and let them know I was on my way in. Vet did Xray's to rule out obstruction but dx with a fecal impaction! My poor baby was FULL OF POOP. I feel so bad the we can't seem to regulate her GI system at all.

I had to leave her at the vet while they did the enema. They kept her for an hour and a half and then we were able to pick her up. She had gone to the bathroom several times and it was normal poo and not bloody at all. We brought her home with instructions to give some Tagamet to help ease her stomach. However, since we got home she still has periods of shaking and acts like it is uncomfortable to lie down. She prefers standing over lying but at this point the poor baby is falling asleep standing up. She has periods where she has slight shaking, nothing, then she will start shaking pretty hard. She finally had a bowel movement (one soft formed brown stool) again a few minutes ago and has gone to pee on her piddle pad 3x since 5:30 PM and seems to be feeling slightly better. No shaking just acting as if her tummy is sore and is hesitant to lie down. I finally put her up on the bed and made her a "nest" as we like to call it so that the front part of her body is elevated as this is how she seems most comfortable. I'm praying that we all get some rest tonight and don't end up back at the vet. I'm hoping that the pain after the enema was related to the peristalsis once her bowels started moving again.

I'm upset with myself for not asking for a pain med for her. I don't hold it against the vet because when we left the office Abbie was so excited to see us that she didn't appear to be in pain. The shaking only appeared again after we got back home. If she is still in pain in the AM I will take her back and request something for pain. Any ideas what would work best in her situation?

Now I'm worried about starting the bland diet and ending up with constipation and a never ending cycle. Vet says that I can add 1/2 tsp of mineral oil to her food when she starts eating again or use just a bite of the pumpkin. Any thought on this as well?

My oh my...I'm plum exhausted. I broke down in tears tonight on my way home from the drugstore. I even had to dose myself with the Tagamet as I think I've given myself and ulcer and possible IBS from the stress of it all. Please pray for Abbie's recovery and my sanity. :(

Oh my goodness :(...I have been here. It can be so scary and you feel so helpless, with these little lives depending upon you. HANG IN THERE. You are doing everything you can to get your girl healthy.

I just want to offer my support, good thoughts, and healing for your sweet girl. I know you'll get her there :).

HGE and pancreatitis isn't really a strong area of mine, so I'm not going to confuse things and offer advice. You already have good folks looking out for you in that area :thumbup:. Just know I'm thinking of you and Abbie.

i would use pumpkin not mineral oil - i use organic pumpkin from whole foods

I have no advice but I wanted to tell you we are thinking of your little one and we will keep you and Abbie in prayers.

UPDATE took Abbie to ER Vet last night
 

First, I just want to say thank you, thank you, thank you for all of the kind words and prayers. I really needed those this morning. Sometimes I just wish she could open her mouth and tell me exactly what is going on.

We ended up taking her to the vet at 11 PM last night. She never could seem to get comfortable, was not able to jump up on the couch or use her bed ramp like normal, and was really "freaking" me out for lack of better terms.

Vet took a LONG time getting her history from me. He did another CBC, Lipase, and Basic Metabolic Panel. The only abnormal results are listed below:

RDW% 16.7 Normal 11-16
Lipase was at the high end of normal at 1192 Normal 200-1800
WBC were in the normal range but slightly elevated at 13.8 Normal 6-17
PCV was high normal at 48.8 Normal 37-55

To make a long story short this is what he thinks is going on.
1. Contracted a virus or stress when she went to vet for yearly checkup last Monday as she was there for 1/2 day being exposed to who knows what
2. Stress or possible table food triggered the pancreatitis (vomitting last Tuesday) which in turn led to the bloody stool and possible HGE Wednesday night
3. Body tried to fight it off until Friday when I took her in for the inital DX of pancreatitis.
4. Was improving but suffered set back because of the new bland diet...this led to the constipation and need for enema.
5. Has no idea where the pain is coming from but thinks it is from her back. and suspects it is not related to the GI upset at all but a total coincidence.

He said Lipase may be in the high normal range because the dx was orginally made almost 5 days ago and she has been on Flagyl since then. Same theory with the high normal HCT.

They placed an IV and gave her fluids, injections of Gentamicin, Baytril and Dexamethasone (for the inflammatin/pain) and sent us home with instructions to stop the Flagyl and Clavamox. Hold food and liquid for 12 hours, start by introducing water at noon, followed by a small spoonful of I/D every few hours. If she tolerates that without vomitting tonight then I am to slowly transition her back to normal food by Friday (he was adamant-no more chicken breast). Once we introduce food, if she won't eat or drink for greater than 24 hours then we are to take her back to our vet right away.
He left the IV in place just in case she needs fluids again. He was a wealth of information, very caring, and seemed genuinely perplexed by all that she had been through. He did make comment that this was an "atypical" case of pancreatitis or she had the highest pain tolerance of any dog that he has ever cared for. He said he would expect her to feel much better by Friday and if she was eating and drinking well that I could remove the IV on Friday morning.

He doesn't want her jumping until the pain has subsided so I made a bed on the floor for Abbie and I since the fluids had her peeing all night long. We were all able to get a few hours of sleep last night. She is a little more alert this morning and not shaking but still won't go up her ramp to get on the bed or even try to jump on the couch (her favorite spot to patrol the neighborhood). I'm hoping for an huge improvement by tomorrow afternoon.

Keep us in your prayers.

How long did he keep her and how much fluid did she receive? I am curious because it sounds like it was done and you took her straight home. Fluids must be infused slowly....very slowly! Definitely not like doing subcutaneous.

Hope she improves quickly.

Lady Jane, they only gave her 175 mls of fluid since she she didn't appear dehydrated and had already received the subcut fluids earlier in the day. They infused quickly but I remember him mentioning the formula for deciding how fast to infuse. Seems like 40 mls hour per 1 pound of weight.

We were there for a little over 2 hours total. We only waited 5 minutes before he saw her. The rest of the time was spent on care for Abbie.

How much does she weigh?

Sorry, I meant to post her weight. :)

She is a "big" girl and is normally 9.6 pounds when healthy. She weighed 9.0 pounds last night before fluids. Based on my calcs they should have infused in about 50 minutes and from my fuzzy sleep deprived memory this seems to be how long the infusion was running-give or take a few.

Sounds like a lot of fluids for a pup that is not dehydrated (which makes me wonder why IV fluids anyway); but I am not a vet so what do I know?

He said he wanted her hydrated since that is the mainstay treatment for both HGE and Pancreatitis. He also wanted to make sure she was hydrated since I am ONCE AGAIN withholding food and water (until this afternoon).

Now that her labs are wnl you are ok with iv fluids. I am so confused...I thought the new diagnosis was that she was fos.
I will pray for her...that this is the fix for her.

WOW This poor dog has been through the RINGER :( The pain is pancreatitis. Here is my concern and do not want to freak you out but steroids can cause pancreatitis and he just gave a dog with pancreatitis a large steroid shot of dexamothesone :( ims told me when dex was so sick and came back with bacteria infection after pancreatitis and they could not get him to stop vomitting that she did not want to do steroid injection because it could trigger the pancreas again so she opted for 24 hrs of sulcrulfate and if he did not stop vomitting she had to do the steroid and take a chance so i know this to be an issue. I think her pain was due to pancreatitis not back. Also dex amylase and lipase were normal when in severe pain and when he felt good were high - sounds odd but I do not put 100% in amylase and lipase anymore after that oddity with him and he had alot of lipase and amylase blood work over a year and it was all over the place. The wbc being high is a sign of pancreatitis.

Ok the HGE i am not buying it as your dog would have been dead if HGE what was the red blood cell count was it over the 55 on any test. HGE your dog would not have been active like you stated on prior posts the dog would be vomitting and diarhea and VERY VERY SICK and would have to be on iv fluids -my friends dog gets it alot as once they have it just like pancreatitis really easy to get again here is what vet does with her dog that gets it

this condition requires immediate treatment of fluids, no solid foods, and a course of anti diarrhea/antibiotic medication...mine are always put on Amphorol and respond very quickly.

I am just confused why clavamox and metronidazole as clavamox is usually used for uti not pancreatitis and not hge - I can see the metronidazole

and i do not understand the whole enema thing :( that had to be very traumatic for her :(

I feel bad for you both as this is all over the map :( I hope she gets better real soon

here is what i would do and what i did when dex was sick after the first relapse I was done with vet I called around to find out who the best in the county was for 24hr fluids as did not want him shuttled from vet office to er daily i wanted him in one place and comfortable and with the best in the county. Everyone named one woman and one facility and it is a specialty hospital and she is an internal medicine specialist. If i were you i would seek this out and if she does not get better please just take all test results and go to them it will save you money in long run and you will get right to the problem much faster and get her care quicker and heal her faster as they have further education in internal organs.

I am not a fan of I/D my dog relapsed on it and internal medicine specialist does not recommend that food for that reason as it has pork in it. She prefers ultra z/d as it is a hydrolized protein so it is broken down so body does not have to work as hard while healing

here is the link to find an internal medicine specialist in your area

ACVIM

put in SAIM in specialty, state, united states

I agree. Dogs with HGE can go into a coma and die within hours if not treated quickly with IV fluids. It's not a disease that lingers for days, then gets better on it's own.

It's also relatively easy to diagnose with the characteristic explosive raspberry jam diarrhea and a PCV over 55. I can't imagine the vet last week would have missed it.

Was this another different vet you saw last night?

Yes, this was a different vet that we saw last night (very experienced and well respected vet in our community who owns his own practice as well as the ER practice). I don't think they can figure out what the heck is going on with her.

To be honest he even said, "OK, I don't really know what is going on with this little one. I can tell you that something is going on GI wise and we will get her past this. It's not an obstruction and I'm still not sure about the pancreatitis dx. The SNAP cPL is a great test but there can be false positives. Amylase and Lipase aren't ALWAYS pancreas specific. She has no abdominal tenderness and in all my years of practice I've never seen a dog who WANTED to eat and BEGGED for treats during an acute episode of pancreatitis. Every dog I've ever treated for pancreatitis has been VERY sick with vomitting and is usually better in 24-48 hours."

I was near tears and he added, "I do not think this is something that is going to take her life. Here is what I'm going to do..." And he began the treatments as I described above.

WHATEVER it was she seems to be a little better today. I have offered a TBSP of water per his directions and she drank it slowly but willingly. I'm not sure I will ever find a definitive dx.

I'm not sure how I feel about the Dexamethasone. I wish I had known about relapse info before I allowed him to give it. There is nothing I can do now but wait and see.

Thanks for the website info. I'm so glad you suggested this as I was even more upset last night when we got home and I realized that I had exhausted my last resource. Not to mention we have paid out over $1000 in 5 days with no real answers. I'm headed to the website that was suggested.

She keeps chewing on her IV bandage and I'm afraid that she is going to ingest the fibers and get sick again. I rewrapped it in bandage tape but she chewed through that when I got up to get myself a drink. Any ideas on how to deter her from chewing on it?

I'm looking forward to the day when I can post good news on here. :(

I'll keep you all posted.

Thanks for the link. I found many vets at NC State which is less than a 2 hour drive from us and one I would willingly make.

If she isn't back to herself in a few days I will pursue this option. How would I get started? Do I call my vet and ask for a referral or would I just call the specialist first? TIA!

Oh and what kind of fees are we talking about? Just a general ballpark range. And what does it mean that they are at NC State University? Are they students doing their internship? Sorry, but I'm totally niave in this area as my husband is active duty military and I haven't dealt with civilian healthcare in 12 years :)

put a cone on her to keep her from chewing the bandage

Forgot to add that I'll pick up a can of Z/D today. Thanks!

I don't have a cone. Is there a way to make one at home?

i would see an internal medicine specialist not a student. I agree with that vet dogs with pancreatitis are really sick my boy was miserable and very ill.

i do not get referrals out here i just go to who i want to go to. What i did is called several vets in area and asked who best in county was with pancreatitis and who had 24 hr fluids no shuttling and i called my friend who owns a pet store and everyone said the same woman so that is who i went to.

the way you described before your dog was acting normal just had this diarhea and a little vomitting. amylase and lipase and cpli can be elevated with ibd as well and the dog acts totally normal with ibd but has bouts of vomitting and bouts of diarhea the vomitting is inflammation in small intestines and diarhea is inflammation in large intestine and ibd runs in this breed alot. What are you feeding again?

a dog that has pancreatitis refuses food and refuses even water - they have absolutely no desire to put anything in their mouth and they are in alot of pain.

sounds like they gave too many meds for diarhea and stopped up your dog if having constipation to have an enema :( I personally would not have had the enema in my dog and would have given pumpkin

ibd is a tough one to figure out sometimes. It mirrors colitis as well as both inflame the intestines.

pick a soft cone and a hard cone up from vet they have them there and for future i get this cone as my girl is in it right now and it is comfortable for her

Miscellaneous Items for small dogs

they also have softee cones at petco in black about $19 i just checked into it and also i have the blow up one from petsmart that works real well but hard for them to drink and eat in it i think but that one i would say is best for not allowing to get to the bandage. Go get them all you can return what does not work :)

hotrodsmom on here makes them too and she may overnight one over to you fast as well