Pancreatitis

In search of a happy ending.

Wiki Commons photo.

At the conclusion of our last column, our hero, Poosky, the Jack Russell terrier, had disappeared overnight, then arrived at my office vomiting, panting, shaking, unable to stand. After considering everything from cyanide to rat poison, we ultimately concluded the source of his illness was likely ingestion of rotten deer carcass out in the woods, resulting in pancreatitis and concurrent gastroenteritis. Our story continues.

Pancreatitis: That’s really just a descriptive term, meaning “inflammation of the pancreas,” but not an explanation for why it occurs. The pancreas is a glandular organ that lies between the stomach and proximal intestines. Many people know the pancreas produces insulin and that inadequate insulin leads to diabetes, but the pancreas has another important function — secreting digestive enzymes that break down fat and protein. When Poosky eats, his pancreas releases little packets of inactive enzymes which shoot down the pancreatic duct into the intestines, where ingested food is arriving from the stomach. Once in the intestines, these enzymes get converted to their active form and begin digesting the dog chow.

But sometimes something goes wrong, and those enzymes get activated prematurely while still in the pancreas. The pancreas then essentially starts to digest itself. Voilà! Pancreatitis. Why does this happen? The reason is often a mystery. Miniature schnauzers seem to have a genetic predisposition to pancreatitis. Maybe Yorkshire terriers, too. Metabolic abnormalities like hypothyroidism, diabetes, or Cushing’s disease seem to increase risk, as do obesity and certain medications. But the majority of cases I have seen in dogs in my career have been associated with overeating fatty foods. Maybe that’s why in cats, who are less likely to binge-eat than dogs, pancreatitis tends to present as a chronic, intermittent disease, whereas canine pancreatitis is most frequently an acute illness. Symptoms in cats can be less dramatic, but the chronic form is more likely to cause irreversible pancreatic damage.

Diagnosing pancreatitis is tricky. Signs vary from mild to severe, and can mimic many other illnesses, from kidney failure to a gastrointestinal foreign body. Symptoms in dogs may include loss of appetite, depression, vomiting, fever, abdominal pain, increased heart rate, and panting. Radiographs may show changes consistent with pancreatitis, but are often completely normal. Ultrasound? A bit more helpful, but not definitively diagnostic. Blood tests? Yup. We did lots on Poosky. But, again, most routine lab tests are not definitive. You get the picture. Many tests may support our suspicions, but most abnormalities seen with pancreatitis are also seen with other diseases. The most reliable blood test for canine pancreatitis is called canine pancreatic lipase immunoreactivity (cPLI.) Let’s skip the technical explanation and simply say cPLI can help confirm a diagnosis in as many as 90 percent of cases, with only about 20 percent false-positives. So did I immediately run one on Poosky?

Well … it was Sunday. A cPLI has to be sent out to a reference laboratory. Via FedEx. Did I mention it was Sunday? There’s no FedEx here on Sunday. Aah, the joys of living on an island. Even if there were FedEx service, it can take three days or more to get results, by which time Poosky was likely going to be better or be pushing up daisies. His owner and I concurred that the test wasn’t a cost-effective step worth taking, especially since our treatment plan would be the same, regardless of the cPLI results. Which brings us to treatment.

There are no specific treatments for pancreatitis. All we can do is supportive care: intravenous fluids, antivomiting medications, pain medication, potassium supplementation, antacids, gastric protectants. Severe cases may require plasma transfusions. Some warrant antibiotics. Some patients may develop life-threatening clotting disorders. Food and water must be withheld until vomiting resolves. This may be a day or two, or sometimes much longer. Poosky was in rough shape. We started treatment, but floated the option of sending him off to a round-the-clock specialty practice with an ICU. His owners opted instead to have me treat Poosky as aggressively as possible during the day, but send him home with them each evening. Although round-the-clock treatment would be the gold standard, I was supportive of this alternative plan. Here’s why.

My very first job working in a veterinary hospital was in Denver in the early 1970s. I was an all-around grunt, doing everything from washing floors to holding animals for the doctors. My employer was, hmmm, shall we say, a Traditional Male, who wasn’t thrilled with women who aspired to become veterinarians. All female employees had to wear white dress uniforms and stockings. (Try gracefully restraining a St. Bernard in that!) But the reason I’m tripping down memory lane is that it was there I saw my first case of pancreatitis, a sheltie named Tony. A great little dog. He was pretty sick, but in those days, animals routinely were hospitalized at veterinary clinics overnight without anyone in attendance. It was my job to arrive every day at the crack of dawn to clean kennels, feed, and start treatments. That morning, 6 am, I had my first experience of discovering a patient dead in its cage. Tony had died overnight from pancreatitis. Alone. It broke my heart. So if Poosky’s dad wanted him home each night, well, that worked for me. If the little guy was going to die, better at home with his family.

Poosky returned day after day. Soon he nibbled a little food and guzzled some water, but then proceeded to vomit again. Things were touch and go for a while. His owners nursed him lovingly at night. We adjusted his treatment by day, keeping him hydrated with intravenous, and, later, subcutaneous fluid therapy. Eventually he began to eat and hold food down. He has now recovered completely, and his family is being vigilant that he doesn’t go scavenging in the woods again. I still think sadly about Tony every time I see a case of pancreatitis. The good news is that now I will also think of Poosky. There’s that happy ending I promised.