Angel Pancreatitis Help Please

[Remy’s Mom]

Hi everyone. Remy’s Mom here. Not ‘Cushings” but I am hoping some of you have experience or advice with pancreatitis since this is one disease I have not had to deal with until now. Angel, our 15 year old toy poodle appears to have it or at least that’s what they’re going with for the time being. Brought her home from the hospital this morning and she seemed much better. They felt she was more likely to eat at home and she finally did eat some GI diet. Ran out to the store for a bit, came home and she had vomited up bile. First time I’ve seen her do this. She’s not one to vomit or regurgitate. She seems hungry but wants no part of anymore of the low fat GI diet stuff, spits it out. Ate a little chicken breast finally. Trying to keep her hydrated. I’m afraid without the IV fluids for support she may start to go downhill again and we will be rushing back to the ER. The plan is to contact Internal Medicine at Louisiana State University Monday morning and try to get her in to that service for a full work up. Angel has a history of elevated liver enzymes but no clinical symptoms until now. We had an extensive work up done two years ago but it was determined that absent clinical symptoms there wasn’t much more we could do. Angel has been under treatment for transitional cell carcinoma (bladder cancer) and she’s done very well. I’m so frustrated to think that after 15 months of surviving TCC she might have pancreatitis which I know can be very serious. The present situation with Covid-19 also complicates things as the Vet school is short staffed, clients aren’t allowed inside with their pets, etc. Guess I am feeling very frustrated, frightened and pancreatitis is new territory for me. So if anyone has any advice or suggestions I would greatly appreciate it!! Thanks so much!! Claire

[labblab]

Hi Claire, I’m so sorry little Angel is having such a rough time right now; I surely understand why you’re feeling so upset and worried about her. I am definitely no expert on pancreatitis, but I did have a bit of personal experience some years ago with my non-Cushing’s Lab girl, Peg. At age 6, Peg started having grand mal seizures of unknown origin. We started successful treatment of her seizures with phenobarbital, but after a couple of months, she also suffered from an episode of acute pancreatitis. Whether or not it was related to the medication, I do not know. But it was definitely a very stressful time for me, because it did take a couple of months to get her GI issues under consistently good control again. In her case, she suffered from both vomiting and diarrhea at various points in time. She was never so acutely ill nor dehydrated to require hospitalization, but worrying about her at home was quite stressful. The initial acute episode kind of morphed into a chronic issue. She would seemingly get settled on a diet of very bland homemade food, but then would relapse again with the GI distress when we tried to advance to commercial food. However, finally she did normalize after a couple of months, and never did experience another acute episode. As a precaution, though, I did maintain her on a lower fat diet for the remainder of her life.

I’m going to give you a link to an article that was very helpful to me at the time. I especially appreciated the dietary information. By all means, I don’t mean this as a substitute for your vet’s guidance. But you may find some additional tips here that may be helpful to you, as well. The article was first written back in 2008, but the author has continued to update it, I believe most recently in 2018.

There were some times during her illness when Peg was inappetant, which was very unusual for her. I was usually quite lucky in that, like most Labs, she was happy to eat anything in her bowl. When she was experiencing GI distress, I followed the advice in this article and offered her multiple very small meals a day of cooked chicken breast and overcooked plain white rice. By “overcooked” I mean cooking the rice in a *lot* of water until it turned into kind of a starchy white porridge. As for the chicken, I found the easiest thing to use was ground chicken breast as it is so lean and so easy to quickly cook up in a skillet using only a bit of spray to keep it from sticking. It was then very easy to crumble up in the rice mixture. I know that many dogs are pickier about their food, and the article has additional tips in that regard. But since Peg would happily eat it, that bland low-fat mixture worked well for us.

My one worry about trying to feed Angel solid food is if she’s still vomiting, because you don’t want to keep reactivating the nausea. As I recall, we were given some oral anti-nausea medication that did help settle Peg’s stomach. But that would be one wild card for me right now — if Angel is still vomiting, you probably best check back in with the vet for more guidance. But in the meantime, here’s that link. Hopefully it may provide some helpful info, and please do keep updating us, OK?

http://dogaware.com/articles/wdjpancreatitis.html

Marianne

[Squirt's Mom]

As for keeping her hydrated, ask her vet(s) about home subQ fluids. It is easy to do and does keep them hydrated when they are not drinking enough on their own.

[Remy’s Mom]

That would be my first thought and I’ve done SubQ before many times. The problem is she’s good at the vet but for me she’s terrible. She will snap if I just try to clean her ears or so anything she doesn’t like. She gets rather large, fluid filled blisters and its a simple matter to poke with a sterile needle and they will drain. HA! Good way for me to lose my hand. So I can’t imagine her tolerating me sticking a needle in her neck. If she would it would be much easier to maintain hydration. What I don’t want is for our relationship to change where she starts to hate me. I think she does figures she can get away with anything around me so I get the “Diva” like behavior whereas she is cooperative for the vet. May have to run her to the ER for some fluids today to keep her going.

[labblab]

Claire, how is Angel doing today in terms of the eating/vomiting? As I wrote earlier, it helped us to have an oral anti-nausea medication on hand to give to Peg while she was recovering at home. I’m sure you would have thought of this on your own, but if you do take her in today, perhaps they can give you some medication to have on hand at home, too.

Marianne

[Joan2517]

I've also gotten boneless chicken thighs or chicken tenders and just boiled them up and shredded the chicken and added that and some of the liquid to the rice. Doree loved it for a while when she was having terrible diarrhea issues, until she got tired of it. I like the ground chicken idea, though.

[Remy’s Mom]

Hi Marianne, Angel was given Cerenia IV at the hospital for nausea and she is on it orally at home. She isn’t really vomiting it’s regurgitating. She also gets famatodine for reflux along with all her other medications. The thing is with the regurgitation I don’t know how much of the medication is staying down. She seems most likely to regurgitate with motion, like while she’s walking or moving in some way. Unfortunately I don’t think she will tolerate sub Q fluids from me. I’m trying to offer some additional water via syringe if she doesn’t seem to be drinking enough. She wants no part of food this morning.��

[Remy’s Mom]

Hi Joan I know you have a soft spot for little poodles too. �� I’m going to see if they have some ground chicken breast. You never know what the store will have since the virus thing started. I think that with the rice might be more palatable to her but right now she doesn’t even want the deli turkey she usually loves. Thought I’d try a bite just to see but she doesn’t want it. I just gave her pain medication so perhaps she’s uncomfortable and once that kicks in she will feel better. I’m feeling so frazzled and over emotional this morning. The cancer was enough to handle and was going so well and now this! I love you all for the support you provide when I feel like I’m one step from falling apart!!❤️

[labblab]

I totally understand the frazzle!! I couldn’t begin to count the tears I shed during that first summer after Peg had the seizures and pancreatitis. And for me, lack of appetite just makes me crazy because all three of my dogs have been Labs and most Labs have to be *really* sick not to want to eat :-(((

It’s just a coincidence, but Peg also suffered from regurgitation issues for most of her later life. Most often, when it happened, the food would just come right back up shortly after she had eaten. But position did seem to play a role. I started elevating her food and water bowls after I read about “megaesophagus” (and no, you don’t need to add to your worries by going there yourself!). In Angel’s case, it’s undoubtedly related to her current digestive irritation. But if she’s still not eating by tomorrow, it’s probably best to see what the vets want to recommend. Strictly from a nutritional standpoint, dogs can actually go for quite awhile without eating. But according to that article, when treating pancreatitis, you typically don’t want to deprive the intestinal system of food in one form or another for a lengthy time.

Hang in there, Claire, and keep writing back whenever you want!

[Remy’s Mom]

Back in the day we had a lab who went to work with us. Charlie would steal the guy’s brown bag lunches off the loading dock if they weren’t careful. LOL! That dog would eat anything and everything so I know what you’re saying!! Inappetence probably makes me crazier than anything else. Especially when you have a senior dog with an ongoing issue like kidney failure or heart disease and you’re trying to keep weight on them. She hasn’t vomited any food other than a few tiny particles, it’s all fluid, like water with a little bile. She’ll jump down off her chair and spit up.Much as I hate to I think I may take her back to LSU thru the ER and get her readmitted. That way Internal Medicine can get involved tomorrow instead of trying to get an appointment with them. Having the vet school short staffed with the virus (and they just graduated the senior class) its the worst time for this!

[Remy’s Mom]

Angel is back in the hospital. She continued to regurgitate and food seems to nauseate her so I think it’s for the best. This way Internal Medicine can get working on her right away and try to get to the bottom of it. She will also get the IV fluids, anti nausea and support meds she needs. I was afraid with all the regurgitation she wasn’t getting the benefit she should. It will be a rough time for us without her but I do feel it’s for the best.��

[labblab]

Claire, I agree with you. Given the situation, I do think you made the right decision. I know it’s so hard to be separated again, but the sooner they can start solving the problem, the sooner she’ll be back home with you, for good. Hopefully you can actually rest a little easier tonight, yourself, knowing she’s under their watchful eyes. Do let us know just as soon as you learn anything more tomorrow.

Sending tons of hugs and healing wishes to you all!
Marianne

[Remy’s Mom]

Thank you Marianne so much! Always such wonderful support here when one needs ‘propping up’. I hope they can get to the bottom of it and resolve the issue. I’ve tried to think of everything from a possible bee sting a few weeks ago to having mulch delivered in late March. Since Angel has never been a ‘barfy’ dog this came out of nowhere. She’s always been a rather picky eater but not to this degree so something is surely wrong. At least I know she is in the best place. They said she’s even in her same little cage as yesterday.��

[Squirt's Mom]

Good move, mom! I would feel better in your shoes as well. It can get very frightening when nothing we do seems to help...and especially with this crisis and our regular vets not readily available I know you made the right move. Try to rest tonite so you can regain some strength. Prayers rising for you all.

[Remy’s Mom]

Thank you so very much! At least I know that if things become more critical she is in the best possible place. They had her on a number of IV medications including fentanyl for pain, a couple of anti nausea meds and the fluids. No wonder she felt so much better yesterday when she came home. Going to try to rest tonight knowing she’s in good hands. Hopefully Internal Medicine can figure out what s going on with my old girl!

[labblab]

Hi Claire, just stopping back by and surely hoping that little Angel is feeling better today. Continuing to send healing thoughts her way!

Marianne

[Remy’s Mom]

Long day, lots of back and forth with her doctor. BUT, it doesn’t seem to be pancreatitis. She feels it’s gastroenteritis. They did abdominal and thoracic Xrays as well as further ultrasound. She is still not interested in food but fasting another day isn’t going to hurt and will give her body a chance to heal. Dr said this may be a bit of a roller coaster ride for awhile with the possibility of relapse but hopefully we can get her feeling like her old self. There was one concern this morning when her glucose dropped quite low. So far she’s never had any issues with glucose so odds of it being serious aren’t likely but if it drops again she will run a test for an insulin secreting tumor just to cover all the basis. They have to et her to the point where she can get along without the IV support. She was still painful this morning. The good news is she is being her little Diva self. Demands to be held and has made sure everyone in ICU knows how special she is �� That sounds like my girl!! Apparently we may never know exactly what triggered all this. Her little vacation from chemotherapy may help too. We just don’t want the TCC to start progressing again. I’m hoping maybe Wednesday she will be well enough to come home. I could always take her on an out patient basis if she needs a little extra fluid support. I think my nerves and emotions are a bit calmer but I will be much happier when she’s back home. So thankful for all the information and support here. Will keep you posted!! Big hugs to everyone. So thankful for those who understand how hard it is being a good mom to the fur kids!

[Joan2517]

Poor baby! It is so nerve-wracking to not be with them. With the virus going around it's curbside pickup at the vet and I hate not being in there while they are examining! My poor Cooper who is a rescue from a puppy mill, is terrified at the vet's, but the last time he went I could't go in and when he realized that, he just screamed while they dragged him in...I sat in the car and cried.

I love that Angel has them wrapped around her little paws!

[labblab]

I love that Angel has them wrapped around her little paws!
I totally agree!!! And reading this update, for sure I think you made the right decision about taking her back in, Claire. Keeping all my fingers crossed that things will quickly stabilize for our little angel, Angel.

[Remy’s Mom]

UGH, heading to the hospital shortly. Angel seems to have developed some potential neurological symptoms so they want me to watch some videos of her moving and help them assess. See how she reacts to me. I’m trying not to panic as my other poodle Amanda went thru a patch of seeming neurological symptoms too and then they vanished. Sometimes I wonder if the specialists just have to many potential symptoms to consider and it gets overly complicated. Angel’s vision is poor, surprised she can still see at all. Between that, all the medications, etc. I can understand her being anxious and apparently she is quite anxious. Hope seeing her mom will help!!

[labblab]

Oh Claire :-))))). Please know we’re right there alongside you in spirit as you head in. Fingers still crossed. *Really* crossed!

[Remy’s Mom]

Thank you all for the positive thoughts and prayers!! I did manage to get Angel to eat a few bites of turkey. Not much but it was something. She still seems a little painful in the belly but the diarrhea seems to be diminishing. They are anxious to see if she keeps the turkey down. I watched the video and felt she was anxious because she needed to pee. Ive seen her rock back and forth like that in her car seat if she needs to go with that ‘anxious’ look. And the doctor said Angel peed on one of the nurses so.....likely that was it. And apparently she relaxed and was more peaceful thereafter. I let her walk a little and she took a very very long pee. They are trying to scale back the fluids and meds and hope maybe Thursday she can come home although she still may not be eating as well as we would like. It may take some time to restore her to proper eating, all the harder as she has always been picky. Such a bundle of emotions!! I’m worn out!!

[Squirt's Mom]

I hope this morning arrives with good news and an Angel that feels much better. Please keep us updated! Prayers continue for all, including her medical team.

Hugs.
Leslie

[Remy’s Mom]

I thought I replied yesterday but guess I didn’t do something right. My girl is home and she was eating before we left the parking lot at the ve school. She ate pretty well yesterday with no regurgitation or diarrhea. Angel is a bit tired but that’s to be expected. I don’t imagine ICU is the quietest or most restful place. She seems very happy to be back home and we are sure happy to have her back. For the moment Angel is on a drug holiday for a few days and we will start to reintroduce her meds in 24-48 Hrs. She remains on meds for nausea and appetite stimulation. Liver enzymes seem to be trending downward which is also good news. Will keep you posted and again, thanks for all the support during this difficult time for me! Thanks to everyone for the prayers and encouragement!!

[Joan2517]

So happy she's home!

[labblab]

:):):):):):):):):):):)

[Squirt's Mom]

Wonderful news! So glad she is back home!

[LtlBtyRam]

So glad you have you girl back!

[Remy’s Mom]

Just a quick update. “Miss Picky” seems to be doing pretty well. Trying to get her to eat a sensible diet isn’t the easiest but she picks at it. She seems to be feeling pretty good and I am slowly cutting back on the anti nausea meds.Still have her on an appetite stimulant for the time. Being. Gradually resuming her regular medications. Fingers crossed that there is no relapse!!
Thanks to everyone for the moral support and advice!!

Hugs,Claire & Angel

[Squirt's Mom]

Sounds like a plan to me! Keep up the good work, Mom!

[LtlBtyRam]

Thumbs up.

[Remy’s Mom]

Well some bad news. Angel’s liver enzymes are to the moon again. I think her problem is the chemo (Chlorambucil) sometimes it can become toxic to the liver/kidneys and after restarting it on Tuesday she was vomiting foam at 4:30 this morning. I did not give it today and had her PCP recheck her blood chemistry. Sure enough it’s super high again. In fact, I don’t think it’s ever been this high. Have a call in to oncologist but I am not going to give her anymore of it. Unfortunately I don’t think we have many options that will not be equally or more harmful to her kidneys and liver. I can only hope the TCC does not progress rapidly. Maybe she will have a few good months left. I have asked about surgery since it doesn’t seem to change much but the doctors seem to feel it is probably within much of the bladder wall even if it isn’t visible. Surgery is usually a poor option for TCC. With chemo she has had 13 good months where she felt good and had no issues. I’m going to pray for a little more good time with her but we are done with this drug. It is usually well tolerated but Angel has a history of over reactions to drugs thru the liver. I’ m thankful we had eight months where she tolerated it well.

[Squirt's Mom]

As tough as it is to make such a decision, I would do the same in your shoes. One of the hardest, most painful, things for me to learn was that there are limits to what I can, and should, do to prolong a life. Angel knows you have done all you can, and more than most, to give her the best life possible for as long as possible. Enjoy every moment you have left. Talk to her, touch her, spoil her rotten, and share with her all the memories the two of you have made together.

We are here anytime you need a soft place to land.
Hugs,
Leslie

[labblab]

Leslie has stated perfectly my own thoughts, as well. I just want to repeat that we are always here for you, Claire. So please come back at any time. We’ll be anxious for updates on how *both* you girls are doing in the days ahead.

Sending tons of hugs and healing thoughts,
Marianne

[Joan2517]

I think the same...there is only so much that we can do, and sometimes too much. I remember when our Saluki Isis had canine lymphoma and we began chemo in January until sometime in May or June, she went into remission after a few months, but it came back with a vengeance. We researched and went to the AMC in NYC to come up with a new protocol. We were beginning the new chemo regimen after Xmas that same year. I will never forget the look on her face when we started it again. She was so tired, so sick and so ready to go. She just wanted peace. My son and I cried the whole way home and when we picked her up, she had given up. The light was gone from her eyes. She got worse as the day went on and around 11pm I called the vet and he met us at his office. It was time, probably past time. We put her out of her misery that night and I swore I would never, ever do that to one of my babies again.

I wish I had done that with Lee....

[Remy’s Mom]

Thanks to everyone for the kind words and support. Fortunately at the moment, Angel is feeling fine. IF I gave her ‘junk food’ she would eat every bite.�� She seems to have good energy and she hasn’t had any incidents of retching since I discontinued the chlorambucil. Still haven’t heard from her doctors. I do know the liver has amazing healing properties so hopefully off the medication it will improve. I think at this point I simply have to say no to more chemo. She really was never ever sick on any of it until the past few weeks where her appetite diminished. I can pray the TCC doesn’t progress rapidly. The only other options would be radiation which would require daily anesthesia and have some nasty side effects for while. It can be very effective if started relatively early but it’s a difficult process and I don’t feel justified in putting such an old girl thru that not to mention I doubt she could handle the anesthesia. My goal now is to make sure it IS the drug causing the spike in liver enzymes and not something related to the bout of gastroenteritis that might be reoccurring since she’s been out of the hospital and off fluids, etc. Don’t want to have tunnel vision here. But as far as further treating the TCC I think we have done about all we can do given her various issues. She’s had nearly 15 months since it was diagnosed and it’s been all good. I don’t want to put her thru Hell with miserable treatments that might give us more time but the quality of her life will be diminished. It helps to know that you would make a similar decision in my shoes. I wish there was a cancer forum that was as informative and responsive as this one!! Hugs to everyone!!