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Old 01-26-2010, 08:50 AM   #1
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Default 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.
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Old 01-26-2010, 01:17 PM   #2
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It sounds like the new vet will get Abbie better. Hope she is better soon.
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Old 01-26-2010, 01:26 PM   #3
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Wishing Abbie well with this new vet. Hope he/she can make him well.
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Old 01-26-2010, 02:00 PM   #4
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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.
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Old 01-26-2010, 02:10 PM   #5
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GLAD you found a vet that knows a bit more, hope she feels better soon.
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Old 01-26-2010, 03:24 PM   #6
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Quote:
Originally Posted by ladyjane View Post
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.
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?

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.
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Old 01-26-2010, 03:54 PM   #7
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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
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Old 01-26-2010, 03:58 PM   #8
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Originally Posted by Ladymom View Post
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?

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.
The other vet did a CBC ... .. ?
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Old 01-26-2010, 05:37 PM   #9
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Default 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.
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Old 01-26-2010, 07:44 PM   #10
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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 . Just know I'm thinking of you and Abbie.
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Old 01-26-2010, 08:02 PM   #11
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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.
i would use pumpkin not mineral oil - i use organic pumpkin from whole foods
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Old 01-26-2010, 11:09 PM   #12
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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.
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Old 01-27-2010, 06:00 AM   #13
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Default 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.
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Old 01-27-2010, 06:05 AM   #14
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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.
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Old 01-27-2010, 06:23 AM   #15
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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.
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