Phoebe, Chronic Pancreatitis and Voracious/Starving

Epi4Dogs Foundation Inc.’s mission is the advancement of science and education relating to EPI (Exocrine Pancreatic Insufficiency), yielding useful insights and positive outcomes in better managing EPI in dogs and cats. Our goals are to support and/or collaborate with veterinary EPI research and researchers, and to promote EPI awareness by educating the general public, pet owners, pet organizations, rescue and shelter organizations, veterinary schools and veterinarians.
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Cranberry21
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Location: New England
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Pet name: Phoebe
My name: Debra

Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Cranberry21 » 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.

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Olesia711
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Location: North Carolina
Country: United States
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Pet name: Izzy
My name: olesia

Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Olesia711 » 14 Mar 2021, 08:47

OMG... my heart is breaking for you and i am humbly in awe, that you are trying/doing everything you can to help her and not giving up, even if she is 18... Bless her!

So, my understanding is that the enzymes did not help.. correct? I am wondering if the test results are skewed IF she is segueing into EPI from end stage chronic pancreatitis... there is a certain window of time when pancreatitis is segueing into EPI that the results cannot be depended upon....but i guess it doesn't matter you just want comfort for Phoebe.

My gal, who had EPI and then developed IMHA too... which was 5 months of pure hell, flip flopped between regenerative and non-regenerative IMHA.... when i say my heart is breaking for you, i truly mean it....

SO.........just out of curiosity....did they check for possible Diabetes.... especially with the IMHA which could have some connection to her pancreatitis....
Also.... YES.... i would "try" a true hydrolyzed food.... with that extremely low folate value.... that might be the underlying cause of all the pain and discomfort and why her body is rejecting everything..........

And the last thought i have... is possible Cushings or A-Typical Cushings....i know you mentioned the hair loss was mostly corrected with the thyroid treatment (glad you thought of that!!) but.... a lot of the symptoms you mentioned AND the fact that the Tylan is not correcting the gas/nasty smell, starving, weight loss, loos stools, etc. I had 3 dogs, one with EPI.... then the other one started showing typical signs.... when tested wasn't EPI... it took 2 long years to think that it might be a Cushings issue.... and it came back "A-Typical Cushings"... in other words the typical symptoms weren't evident..... once they started him on Lysodren (for Cushings) OMG all the symptoms started disappearing within 1 week. It was amazing.... especially since nothing (until the Lysodren) ... and i mean nothing!!! helped especially with the loose stool, voracious appetite and loose stools.... also.... Cushing tends to hit the older pups....... not saying that this is what is going on, but i am wondering if it is a possibility.

In the meantime.... i will contact one of our reps who is very knowledgeable with Pnacreatitis.... and i suspect she can help you much more than i can with the pancreatitis aspect.

Please keep us posted. and sending you tons and tons of good vibes!
Olesia, was owned by Izzy, a 35lb Spanish Water Dog (SWD), Diagnosed at 1.5 years old - TLI results 1.. Izzy passed away on February 13, 2020 at 15 years old. She lived with EPI for 13+1/2 years. It was because of Izzy that Epi4Dogs was started... she was the inspiration. May her legacy of helping others with EPI continue for as long as needed.........

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Madelon
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Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Madelon » 14 Mar 2021, 10:31

Phoebe is one lucky little puppy to have such a dedicated, caring mom! I am in awe - I can tell by reading your post how much you love your sweet girl and the all that you've gone through to help her.

Olesia is the expert here so you're in the best hands. I too picked up on the extremely low folate which can indicate a food sensitivity so I too would suggest trying a TRUE hydrolyzed canned prescription food.

Please please keep us posted on what/how things are going. Sending lots of cyber hugs.
MADELON and Doc. DX EPI and SIBO: 5/22/2015
Test Results: (1st) 7/2014 = TLI 16.5, B12 894, Folate > 24; (2nd) 5/2015 = TLI < .4, B12 406; Folate >24; (3rd) 10/2015 TLI < .4; B12 >1000; Folate 14.4. Prior to DX: May 2014 (2mos) - DX coccidia/bladder infection; July 2014 (3mos) 1st EPI test = TLI 16.5, B12 894, Folate >24 - Dx SIBO not EPI; Feb 2015 thru May 2015 - weight loss only; May 2015 vomitted several times, diarrhea and eating poop. Regimen: 4 cups Sport Dog Food Elite Herding - Diane 6x 1tsp per cup; 1 WonderLab PetFactor B12 2x day; 1/2tsp Slippery Elm 2xday; Multivitamin; 1 Zyrtec 10mg 2x day; Salmon Oil

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jilbert57
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Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by jilbert57 » 14 Mar 2021, 11:36

Hi Debra,
I am so sorry Phoebe is having issues. With what I am reading this sounds like an allergic reaction to things. Just a thought have you ever tried a dog dose for weight of Benadryl? With your vets approval.

I am with Olesia that I would try a true hydrolyzed diet to see if it can calm the gut and maybe work. Not sure of the fat content in those diets.

Mickey never used Gabapentin but I do know one side effect could be diarrhea. He was on Tramadol for pain.

He had developed pancreatitis after trauma to the pancreas during liver surgery in 2012 at 13. Then it turned chronic as in his cPl stayed 800-1000. However when I started using porcine enzymes(enzymediane.com) consistently his poops firmed up and his Tli came down to 25. It was >50 during the first 3 or 4 months.

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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Cranberry21
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Posts: 56
Location: New England
Country: United States
Pet name: Phoebe
My name: Debra

Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Cranberry21 » 14 Mar 2021, 23:18

Gosh, thanks so much to all 3 of you for responding to my ocean of a post.

So I’m going to try to fill in any blanks (can you imagine there are any?), and answer your questions. And ask a few of my own, as I’m supposed to speak with her vet tomorrow.

Olesia, by enzymes helping, can you help me understand what I’d be looking for in the beginning? (I feel pretty stupid asking this, but I don’t know what happens “at first.”) What I saw was much more gas (and perhaps this is a stinky stage along the way…). I chickened out, as the bloody poos and her howling over the gas in her digestive tract made me feel afraid I was hurting rather than helping. Plus I didn’t run it by the vet first. I know—bad—and one reason I kept the dosing to what could fit on the ¼” tip of my tiniest paring knife. Of course Phoebe’s comfort is of great concern to me, esp due to her age. But I would love to see her gain some weight back and enjoy a few more adventures with me, even if they are just to the beach or to the “fun” park.

Re: the non-regenerative anemia, I’ve barely researched that…first reads scared me off (and I don’t scare too easily). I believe the vet is basing his dx on her last lab results, so one blood test. I have a whole spreadsheet on her results (to 2014), so if I know what numbers to look at (or provide), or if you have a resource you can direct me to for newbies on this, great!

No check for diabetes or Cushings. Addison’s was checked in the month before her gallbladder surgery, with neg. results. None of her history of blood tests show elevated glucose, and her U/As have never shown glucose in her urine. I think those are the indicators? As for Cushings, (and diabetes and hypothyroidism) it is more common in dogs who have had gallbladder mucoceles (GBM). And Border Terriers (Phoebe) are an overrepresented breed with GBMs. Research is ongoing to figure out the “whys,” but I think Cushings is definitely something we would want to rule out (she’s panting like mad at this evening and has a number of other signs of it…and perhaps it's atypical, somewhat like the unexpected hypothyroidism dx—vet said he’d never seen a dog her size have that, esp without some of the more obvious symptoms).

Jill, I haven’t tried Benadryl with Phoebe. I’ll ask the vet. Thanks for that and the observation about Gabapentin. That’s a tough one as I can’t give Trazadone (anxiety) with Tramadol (vet worries about serotonin syndrome).

**And to Olesia, Madelon, and Jill, I’m wondering if you could give me a little more definition about a “true” hydrolyzed food. I’ve read that with some “hydrolyzed” foods only the protein is hydrolyzed. Is that what you mean? I have no experience with RX foods, so in the dark here.

Questions for all: Do you think I should supplement folate? What else might I try for gas and soft stools? (So far today is better w/out bloody diarrhea…) I’ve had a suggestion about using a wee bit of MCT (like very little). Is that a terrible idea for chronic pancreatic dogs?

I really appreciate your warm welcome and positive vibes. Phoebe is my retired service animal (she is small but she was great in the day), and I owe her my best.

With gratitude!!

Debra

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Cranberry21
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Posts: 56
Location: New England
Country: United States
Pet name: Phoebe
My name: Debra

Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Cranberry21 » 14 Mar 2021, 23:43

P.S. I happened on the link on this site re: perianal fistulas...I think Phoebe may have one of these, so will speak with vet about the ointment. She had a round of prednisolone this summer and the side effects were awful. Any other thoughts?

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jilbert57
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Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by jilbert57 » 15 Mar 2021, 09:18

Hi Phoebe,
The Royal Canin Ultamino hydrolyzed diet is recommended, but you can consult your vet for sure. What dose Gabapentin is your pup on?

Jill
My name is Jill and we live on the Hood Canal in Washington State. We currently have one pup. TJ is a 5 year old Jack Russell.

Mickey and his pancreatitis brought me to Epi4dogs.com site in 2012 to help manage it.
He lived from 6/99 - 8/2014

Mickey, Jack Russell. Chronic Pancreatitis. Dianes enzymes, 1/8t 3x/day with meals.

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Cranberry21
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Posts: 56
Location: New England
Country: United States
Pet name: Phoebe
My name: Debra

Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Cranberry21 » 15 Mar 2021, 09:50

Ah, great! Thanks for that.

She’s on 50mg 4x daily. Could that really cause bloody D?

Best, Debra

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Jean
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Pet name: Kara, lost 10th May 2019
My name: Jean

Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Jean » 15 Mar 2021, 10:31

Welcome from the UK I am sorry I dont know much about Pancreatitis

you have the best advice we can give from Olesia and Jill

Jean
My name is Jean we live in Liverpool in Uk

My Kara born 21 July 2009 diagnosed with EPI by cTLI test August 2010 TLI = <1...folate 14 Cobalamin 408, shot down to 94, b12 injections every other day

Lowest weight 39 pounds

We used Panzym enzymes, Tylan and Chemeyes b12 capsules

Sadly, on 10th May 2019, we lost her to DM


Jeanx

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Cranberry21
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Posts: 56
Location: New England
Country: United States
Pet name: Phoebe
My name: Debra

Re: Phoebe, Chronic Pancreatitis and Voracious/Starving

Post by Cranberry21 » 15 Mar 2021, 12:14

Hi Jean,

That's ok! Thanks for the welcome.

Best, Debra

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