Pancreatitis
 

My 11 year old female yorkie has been struggling with pancreatitis.
Her initial symptoms were loose stool that transitioned to bloody diarrhea and vomiting. The transition from normal stool to the bloody diarrhea was fast. At 8PM Friday all seemed normal to 8 AM Saturday diarrhea. We had her at vet at 9AM SAT. She was treated with cerenia, IV fluids, metronidazole and propectalin probiotic. Her medical history being remarkable for complicated urinary tract infections and bladder stones as a 2 year old had us feeding her Royal Canin SO.
This food manages her urine pH well but due to it's fat content can be tough to digest. Her food was changed to ID for sensitive stomach.
This Sat appointment was with vet she's never seen.
Monday AM I got in touch with her vet and she saw him that week. He switched her food to Royal Canin GI tapering it in fully in 5 days.
Her symptoms resolved quickly from initial bout but upon stopping the metronidazole had a flare up or continuation( ?) of problem 36 hours later.
She was treated with same meds with prolonged course of metro and probiotic a second time, responded well and 36 hours after stopping combo had third flare up.
She's had blood work twice and just got abdominal US results back that showed normal age related changes to adrenals, kidneys and liver. It revealed inflamed loops of intestine and pancreas but no masses.
The internist now suggests long term probiotic with 3 month tapering of metronidazole.
Has anyone else dealt with recalcitrant case of pancreatitis and how if so was it managed?

Hi jimmy85,

I'm so sorry you and your yorkie are dealing with this and hope others who are dealing with this or have dealt with it will post further.

While I have not dealt with yorkie pancreatitis yet, it is an active topic here on YorkieTalk. If you search either/both "pancreatitis" and "metronidazole" you'll find many posts.

One thread that returned when I searched was "states of pancreatitis?" Includes what seems extended article about pancreatitis.

Thank you for lovin' your little one.--KatysMom

Hi Jimmy - when you say blood tests were done - was there specifically something done called a "GI Panel" - bc that would be essential here.

I would absolutely have this kiddo on a prescription diet for life - either Royal Canin GI Low Fat, or perhaps Royal Canin HP down the road...or similar in Science Diet.

Many people, understandably, don't realize just how serious and life threatening Pancreatitis really is; and it can be extremely painful in some cases (which may be masked by dogs). It can take dogs and humans MONTHS to heal from it. It is not uncommon at all for humans to end up in the ICU due to it. One of our own members here at YT (only in her 30's), ended up in the ICU for I think about 17 days, and nearly lost her life. It was very scary.

So, don't be surprised if it takes a very long time to see her back to her normal self.

How are her kidney levels?

Thank you for the responses and kind thoughts for Charlie.
She did have a GI panel done with her normal vet. The original blood work was the desk top test that reads a positive or negative for pancreatitis. Within that panel another test for pancreatitis was done which reveals a numeric value for inflammation to the pancreas and it read 217 and above 216 was considered positive for pancreatitis. The first two treatments Charlie seemed to bounce back quickly, but this third bout (or simply the continuation) she has not rebounded as quickly. This third time she wasn't given the probiotic but I'm picking that up today. I was glad to hear the vet suggest a prolonged taper of the metronidazole for the next 2.5 months but my concern is her kidneys.
Her kidneys have shown to be working well through numerous urinalyses and a special test that has been done at University of Tennessee.
There hasn't been any protein in her urine and her specific gravity has always been normal and very consistent.




After she had her urinary bladder stone surgery as a pup I would take her urine for analyses roughly every 8 weeks for evaluation and I would check pH at home with litmus paper weekly. I know our vet is in a tough spot trying to manage pancreatitis in a dog with atypical Cushing's with a med that tends to be rough on the kidneys.
Hearing that it may take a little longer for her to get back to her normal self makes me feel better. Her ultrasound report from yesterday sounded more grim than I would like. Her vet said that if when we begin taper down of metro if she flared back up the next step would be a needle aspiration of the pancreas. I didn't like the sound of that.
I greatly appreciate your input.

Pancreatitis
 

So sorry to hear your girl has P and urinary issues together. Trying to balance a diet that is right for both conditions is taxing , I am sure. You certainly are doing all you can with testing and diet to take care of Charlie.
As others have said P is a cruel disease, and treatment of it alone requires a very strict low fat diet and constant monitoring for symptoms, so that the disease can be treated before the P becomes severe. But when you have urinary issues too that require different diets and treatment, that is tough. Hoping the regimen she is on now keeps her well.
I hate to mention this, but I am sure your girl is not like mine was as her kidney function seems good. My dog developed sudden kidney failure and had P at the same time ( although I did not know that). This combination was so severe that she didn’t make it. The vet hydration helped with the kidney failure but I think the P disease was her downfall. My dog had no GI symptoms prior to the sudden onset of the kidney kidney disease.
Praying the meds she is on now make her better and that the urinary issues are minor enough to allow treatment to be mainly for the P. I feel for you trying to balance the treatment of a dog with multiple health issues, but you seem to be doing a great job so far.
Wishing you the very best of luck with your girl and we look forward to updates to know how she is doing.

Has the vet mentioned adding Bio-Case to the regimen at all..? Some of the vets I know will add this in during severe pancreatitis episodes.


https://www.thomaslabs.com/product/b...reatic-enzymes

The addition of Bio Case hasn’t been mentioned.
On the bright side Charlie has regained her swagger. She’s playing again and eating like a champ. I’m praying that this treatment makes her feel better.
Charlie tends to be a little hunter and I think the beginning of her pancreatitis could have started from 2 other possibilities. She occasionally will consume a piece of a worm on a walk ( before I can scoop her up and pry it out of her mouth) and she will attack the tiny green tree frogs we have in the Savannah area. I’m a helicopter parent but she’s quicker than me and sometimes may have swallowed something she shouldn’t be eating.

Charlie update:

Charlie has regained her appetite and swagger. She’s now eating Royal Canin GI Food. She has been on Metronidazole 1/day x 4 weeks, then 2/day x 4 weeks, now every third day x 4 weeks.
Each time we stopped metronidazole her pancreatitis returned. She’s done well with this taper. Our vet has her on probiotic and has RXd is an emergency kit if Metronidazole, Cerenia and pro pectalin in case she’d get sick late night, etc.
Once she’s done with Metronidazole every third day our vet wants to get her on something that can be taken long term with fewer side effects than Metronidazole.

Hi Jimmy85,

Thank you for the update. Not sure the news could be any better.

Bless you for taking such care of your little one. Sometimes, being a helicopter parent is a really good thing.

Perhaps others can suggest a med alternative to Metronidazole.

Continuing to wish you the best on this one. --KatysMom

P
 

I am sorry that your poor baby gets P again if the Metro meds are stopped., but it is good that the regimen she is on now keeps her well. I wonder why stopping the Metro brings on a P bout? When my dog had a mild case of P, caught early, Metro was never prescribed. But he was put on Pepcid, and I kept him on that until I tapered it to zero. He had been P free since eating the Hills Prescription ID Low Fat kibble.
Perhaps further testing could be suggested by the vet to see if something else is going on that sets off the P again? Anyway, if all it takes is another med to replace the Metro that will be great. Wishing your baby a P free life, and please keep in touch as P seems to be a big deal with many Yorkies, and we would be interested in your experiences and treatments.