Phoebe, Chronic Pancreatitis and Voracious/Starving
Posted: 14 Mar 2021, 01:15
Hello,
I'm here to try to find help for Phoebe, an almost 18yo Border Terrier with Chronic Pancreatitis. She is starving, voracious, has bloody diarrhea, then semi-formed, then sort of normal, then mucus.
Background: Mar 2018 Dx Pancreatitis, first confirmed episode (spec cPL 1885) & CKD IRIS stage 2 (first elevated SDMA 21). Phoebe has yo-yoed ever since with spec cPL ranging 64-2000.
In May 2018, she had emergency surgery to remove gallbladder w/mucocele and heavy bacterial infection. There was great deal of inflammation in most of digestive system from assumed ascending bacterial infection (Enteroc. sp); could not rule out IBD but no definite finding; stomach gastritis, no helicobactor, liver micro abscesses/bacterial shower. No neoplasia found in multiple biopsies.
Aug 2018 Cobalamin 255, began 0.4ml weekly injections; Nov 2018 614; Mar 2021 >2000. Mar 2021 Folate 1.4; yesterday vet prescribed 200mcg human grade tabs.
Jan 2021: Dx Hypothyroidism (fT4<0.3 ng/dL, fT4 <3.9 pmo/I/L, TSH 4.8); I requested a thyroid panel due to worsening neuro symptoms, alopecia on tail/neck, among other concerns. With thyroxine, hair has almost grown back. Initially balance improved dramatically, but extreme weight loss is outpacing improvements.
Jan 2021: Dx UTI, virulent E.coli antibiotic-resistant to all but 4 drugs; treated w/2 weeks Nitrofurantoin. Antibiotic was extremely hard on Phoebe's system.
Mar 2021: Dx Non-regenerative anemia. Labs show elevated liver values (ALP 137, ALT 139, AST 82, GGT 15). Previous elevated liver values have been treated per ultrasound as presumptive ascending bacterial infection. Awaiting appt. for current ultrasound.
(Finally) Re: EPI: Nov 2018 cTLI >50 (spec cPL 656); Mar 2021 cTLI >50 (spec cPL 1319).
Since Sep 2017, Phoebe's diet has consisted of home-cooked boiled skinless chicken breast w/equal part over-boiled white rice; calcium (added to match phosphorus per nutriondata analysis). Other than medications, I haven't been able to feed her anything else in an ongoing way without setting off a pancreatic flare or full blown pancreatitis episode. So she has lost a little weight each time, then just about gains it back when she crashes again. She can eat no fats, and can't even tolerate SQ B-complex without digestive upset (diarrhea and inappetence).
Per nutritiondata analysis, when she is feeling at her best she consumes 676 kcals/day. She needs to eat about 300 kcals/day to maintain her weight. The vet claims that he isn't a nutritionist, so has no idea what could be causing her to become emaciated while eating 2x her caloric needs.
I'm terrified by what I'm seeing, a voracious dog who eats every 3 hrs, who is gobbling snow, gnawing at wooden house trim, licking the walls—all new behavior. And the pace of weight loss has accelerated over the past year. She started out weighing over 17 lbs in the 2018 (overweight) before her surgery. She now weighs 11.2 lbs, while eating the same huge amount of calories for about 3 yrs.
I know that her diet is woefully deficient and that her time is short. Still, something is very wrong and because her pancreas is so uncooperative, I am wondering if there are things that someone here with more experience than I have has any suggestions or ideas for me (the vets throw up their hands and say they don't understand the spec cPL test or pancreatitis).
Currently, in addition to the voracious eating/weight loss, Phoebe (as I mentioned above) is having all manor of abnormal, foul smelling stools. Her vet has her on Tylan, believing that she is still recovering from the harshness of the Nitrofurantoin she took for the UTI in Jan. Her stools seem to come in big waves, with what is like a series of train cars, each bit of stool a different color, consistency, texture, etc. She is also very gassy and rumbling, something that has increased over the past year.
In the past week, I've tried adding digestive enzymes to her food (BioCase, incubated), just the amount that will fit on the tip of my smallest paring knife. This seems to set off a gas explosion. The only thing that helps give her relief (and she's in a tremendous amount of distress when the gas gets going) is a drop or two of Ovol (for babies, but I tried it at a friend's suggestion). I got some SeaCure; she seems to have tolerated the little sprinkles I've added to a couple of meals. I gave her slippery elm powder (⅛ tsp, 2x day) while she was on the Nitro in Jan. as the Nitro was so caustic. That seemed to be helpful. Sometimes a wee bit of pumpkin (approx. 1/32 tsp) helps put her on back on track re: diarrhea. I give her daily SQ fluids to make sure she stays hydrated.
I know this is long and dull. I know that she is elderly. I also know she is an incredibly strong dog. I don't know if she's on a chronic pancreatitis to EPI spectrum or not. But from reading on this site, I can see that you all have compiled the most information about the pancreas that I have ever been able to access. And I'm hoping someone might have experience with a dog like Phoebe and will be able to point me in some direction. Hydrolyzed food? Grain-free food? Something more than a ton of puréed food that melts away?
I'm deeply grateful for any thoughts or suggestions,
Debra
Medications: Ursodiol 62.5mg/day; Pepcid 2.5mg/2x day; Gabapentin 60 mg/5x day (temporarily up from 2x/day); Cerenia 16mg/1x day; 150ml Lactated Ringers/day; B-12 injections 0.4ml/1x week; CBD transdermal gel 2mg/day; Thyroxine 0.075mg/2x day; Tylan 1/12 tsp 2x/day; Trazodone 12.5mg/1x day.
I'm here to try to find help for Phoebe, an almost 18yo Border Terrier with Chronic Pancreatitis. She is starving, voracious, has bloody diarrhea, then semi-formed, then sort of normal, then mucus.
Background: Mar 2018 Dx Pancreatitis, first confirmed episode (spec cPL 1885) & CKD IRIS stage 2 (first elevated SDMA 21). Phoebe has yo-yoed ever since with spec cPL ranging 64-2000.
In May 2018, she had emergency surgery to remove gallbladder w/mucocele and heavy bacterial infection. There was great deal of inflammation in most of digestive system from assumed ascending bacterial infection (Enteroc. sp); could not rule out IBD but no definite finding; stomach gastritis, no helicobactor, liver micro abscesses/bacterial shower. No neoplasia found in multiple biopsies.
Aug 2018 Cobalamin 255, began 0.4ml weekly injections; Nov 2018 614; Mar 2021 >2000. Mar 2021 Folate 1.4; yesterday vet prescribed 200mcg human grade tabs.
Jan 2021: Dx Hypothyroidism (fT4<0.3 ng/dL, fT4 <3.9 pmo/I/L, TSH 4.8); I requested a thyroid panel due to worsening neuro symptoms, alopecia on tail/neck, among other concerns. With thyroxine, hair has almost grown back. Initially balance improved dramatically, but extreme weight loss is outpacing improvements.
Jan 2021: Dx UTI, virulent E.coli antibiotic-resistant to all but 4 drugs; treated w/2 weeks Nitrofurantoin. Antibiotic was extremely hard on Phoebe's system.
Mar 2021: Dx Non-regenerative anemia. Labs show elevated liver values (ALP 137, ALT 139, AST 82, GGT 15). Previous elevated liver values have been treated per ultrasound as presumptive ascending bacterial infection. Awaiting appt. for current ultrasound.
(Finally) Re: EPI: Nov 2018 cTLI >50 (spec cPL 656); Mar 2021 cTLI >50 (spec cPL 1319).
Since Sep 2017, Phoebe's diet has consisted of home-cooked boiled skinless chicken breast w/equal part over-boiled white rice; calcium (added to match phosphorus per nutriondata analysis). Other than medications, I haven't been able to feed her anything else in an ongoing way without setting off a pancreatic flare or full blown pancreatitis episode. So she has lost a little weight each time, then just about gains it back when she crashes again. She can eat no fats, and can't even tolerate SQ B-complex without digestive upset (diarrhea and inappetence).
Per nutritiondata analysis, when she is feeling at her best she consumes 676 kcals/day. She needs to eat about 300 kcals/day to maintain her weight. The vet claims that he isn't a nutritionist, so has no idea what could be causing her to become emaciated while eating 2x her caloric needs.
I'm terrified by what I'm seeing, a voracious dog who eats every 3 hrs, who is gobbling snow, gnawing at wooden house trim, licking the walls—all new behavior. And the pace of weight loss has accelerated over the past year. She started out weighing over 17 lbs in the 2018 (overweight) before her surgery. She now weighs 11.2 lbs, while eating the same huge amount of calories for about 3 yrs.
I know that her diet is woefully deficient and that her time is short. Still, something is very wrong and because her pancreas is so uncooperative, I am wondering if there are things that someone here with more experience than I have has any suggestions or ideas for me (the vets throw up their hands and say they don't understand the spec cPL test or pancreatitis).
Currently, in addition to the voracious eating/weight loss, Phoebe (as I mentioned above) is having all manor of abnormal, foul smelling stools. Her vet has her on Tylan, believing that she is still recovering from the harshness of the Nitrofurantoin she took for the UTI in Jan. Her stools seem to come in big waves, with what is like a series of train cars, each bit of stool a different color, consistency, texture, etc. She is also very gassy and rumbling, something that has increased over the past year.
In the past week, I've tried adding digestive enzymes to her food (BioCase, incubated), just the amount that will fit on the tip of my smallest paring knife. This seems to set off a gas explosion. The only thing that helps give her relief (and she's in a tremendous amount of distress when the gas gets going) is a drop or two of Ovol (for babies, but I tried it at a friend's suggestion). I got some SeaCure; she seems to have tolerated the little sprinkles I've added to a couple of meals. I gave her slippery elm powder (⅛ tsp, 2x day) while she was on the Nitro in Jan. as the Nitro was so caustic. That seemed to be helpful. Sometimes a wee bit of pumpkin (approx. 1/32 tsp) helps put her on back on track re: diarrhea. I give her daily SQ fluids to make sure she stays hydrated.
I know this is long and dull. I know that she is elderly. I also know she is an incredibly strong dog. I don't know if she's on a chronic pancreatitis to EPI spectrum or not. But from reading on this site, I can see that you all have compiled the most information about the pancreas that I have ever been able to access. And I'm hoping someone might have experience with a dog like Phoebe and will be able to point me in some direction. Hydrolyzed food? Grain-free food? Something more than a ton of puréed food that melts away?
I'm deeply grateful for any thoughts or suggestions,
Debra
Medications: Ursodiol 62.5mg/day; Pepcid 2.5mg/2x day; Gabapentin 60 mg/5x day (temporarily up from 2x/day); Cerenia 16mg/1x day; 150ml Lactated Ringers/day; B-12 injections 0.4ml/1x week; CBD transdermal gel 2mg/day; Thyroxine 0.075mg/2x day; Tylan 1/12 tsp 2x/day; Trazodone 12.5mg/1x day.