Acute Pancreatitis in a Dog: The Project That Is Cookie—Pancreatitis Up Close And Personal

Pancreatitis is an inflammation of the pancreas.

One of the jobs the pancreas has is the production of enzymes essential for food digestion. When these enzymes go rogue, they begin digesting the pancreas itself.

Further information: Pancreatitis in Dogs

Acute Pancreatitis in a Dog: The Project That Is Cookie—Pancreatitis Up Close And Personal

Cookie’s story

Vomiting, diarrhea, and lethargy. Combination of symptoms that sent us to the vet, yet again.

I had dogs vomit before. Throwing up once and feeling better afterward doesn’t worry me too much. Diarrhea depends on how bad it is and how long it lasts. Lethargy is another story. That by itself would be enough to worry.

Combination of all three? Definitely worried.

How it happened

Cookie spent the weekend at the horse farm, as she loves doing. She had a great time running in the snow and playing with JD. Both days she came home happy and bouncy, had her Kong and went to rest.

Sunday evening she really looked zonked.

Yes, she did a little more running around in the snow but to be THIS tired? Tired enough not to want to move and not want her dinner? It was suspicious.

As time went on, she looked even more tired. When invited to go potty she got up and stood there for a while in a way I didn’t like. She went out but it didn’t make sense to me that’s she’d be that exhausted.

At night she just slept, didn’t bother me for play at all.

Normally I’d be thankful to get some work done but not when something about all this felt wrong. I offered some food again and she ate some. Maybe she really was just tired?

Something is not right

If I knew what was really brewing I wouldn’t have enticed her to eat. But I didn’t know.

Early in the morning, I woke up to the sounds of vomiting.

Cookie threw up some bile. There was nothing suspicious in it, just yellow slime. Perhaps her belly was upset from something she munched on at the farm. She got it out of her system and should start feeling better. That’s what I expected to happen.

I checked her belly, it wasn’t hard or distended but it seemed to me she was arching away even from my gentle touch.

And her face, her face definitely looked wrong.

I know I’m very paranoid and I try my best not to make a mountain out of a molehill. But I was concerned enough to discuss with hubby what his schedule was and ask him to keep his cell on.

Cookie went back to sleep but even the way she was sleeping looked wrong. Typically she’s sprawled comfortably.

Vomiting again

She slept until noon and got up only to throw up again. Now I really wasn’t happy and got on the phone with our vet. Cookies gums didn’t look great to me either. He agreed that Cookie should be seen. After I hung up the phone Cookie went potty. At first, to my relief, the poop was coming out good … just to be followed by diarrhea.

That was the last straw.

I did my best to collect some of the poop and tried to see what’s in it. But the liquid mostly just colored the snow it hit. What I could pick up I put in a jar and in the fridge and got on the phone with hubby.

Half an hour later Cookie was on her way to the vet.

At the veterinary hospital

Even though she remained social, the vet could immediately see how lethargic she was. A bit change from the typical fireball she is.

They checked the stool and found bits of grains and corn. The assumption was that Cookie got into the horse feed. Her abdomen was painful on palpation. Both large bowel and small bowel diarrhea with foreign material present. She was showing signs of mild dehydration.

Originally the vet thought we’d do x-rays but after he examined Cookie, and with all the latest information, he felt it was not as much likely and it was decided to pass on imaging for the moment.

Cookie got a shot of antibiotics and antiemetics and some more to take home with her.

Pancreatitis?

It was also decided to run a full blood panel, including PLI test for pancreatitis.

Cookie was to fast for 24 hours but was encouraged to drink. She had no interest in that at all, though, so we ended up having to syringe an electrolyte solution into her.

She didn’t mind she wasn’t allowed to eat, she had no interest in food at all.

We were watching, hoping for improvement and waiting for the lab results. She looked a little better by the end of the day but still bad enough, even though she did show some interest in playing later on.

Whatever this was, she looked very sick.

Diagnosis confirmation

The next morning the results came back and, indeed, Cookie has “mild” pancreatitis. Mild and already looking so badly? Scary stuff.

Because of the diagnosis, Cookie was put on Hill’s i/d can diet. We did try using it for Jasmine back in the day and Jasmine hated it. I was happy to open the can and find out that it is quite different today than it was then. Much more palatable and Cookie agrees, at least for now.

She was quite happy to accept it as her Kong filling in order to get multiple tiny meals into her on the first day.

So far she held it down and continues to improve. Pancreatitis isn’t something to mess with.

Cookie is recovering. She isn’t obese and she didn’t get any fatty table scraps. The hypothesis is that she got it from eating horse feed, based on what was found in her runny stool.

How is pancreatitis diagnosed?

Cookie was lethargic, then she threw up twice without feeling better afterward and she had diarrhea. That’s a combination of symptoms I didn’t like at all, so we took her to the vet right away.

The vet also noted a painful belly and we decided to run blood work. While we were waiting for the results, Cookie got antibiotics, antiemetics and was to fast for the day. She had no interest in food anyway.

Cookie’s bloodwork

Symptoms of pancreatitis

Typical clinical signs associated with pancreatitis include:

abdominal pain, anorexia
vomiting
diarrhea
dehydration
weakness
and lethargy

However, these are not all present in every case.

Because Cookie only got a chance to throw up twice and we got her to the veterinarian so quickly, she was only mildly dehydrated. When I was examining her gums, they didn’t look right but I couldn’t put my finger on it. They didn’t really look pale or gray but didn’t seem to have the normal pink color either.

The original plan was to take x-rays or ultrasound of Cookie’s abdomen, but based on the examination and description of events, Cookie’s vet decided that we’ll run the blood first and go from there.

Related blood test values

Amylase and lipase enzymes

In the old days, amylase and lipase (enzymes made by the pancreas that help digest starch and fats) were used when diagnosing pancreatitis.

They are not accurate criteria, though. There was one time when Jasmine’s lipase was very high and yet further testing confirmed she did not have pancreatitis. And as you can see, Cookie’s amylase and lipase are perfectly normal.

Further reading: Your Pet’s Serum Lipase Level

Serum Spec cPL

Fortunately, better testing is available now. The spec cPL (specific canine pancreatic lipase) test does a better job in diagnosing acute pancreatitis and has come to be the test of choice.

It’s not perfect, however. Sometimes abdominal ultrasound or even exploratory surgery is necessary to definitively diagnose pancreatitis.

Idexx Laboratories provides a guideline on how to interpret spec cPLvalues.

< or = 200 ug/L – Serum Spec cPL concentration is in the normal range
201 – 399 ug/L – Serum Spec cPL concentration is in the questionable range. The patient may have pancreatitis and serum Spec cPL should be re-evaluated. If clinical signs are present, treat appropriately and perform additional diagnostics to investigate other differential diagnoses. Repeat the Spec cPL in 1-2 weeks. If no clinical signs are present, recommend retesting in 3-4 weeks.
> or = 400 ug/L – Serum Spec cPL concentration is consistent with pancreatitis.

An interesting point to make about T4

One interesting point to be made is about Cookie’s free T4 (thyroid hormone).

It does not make sense to run this test on a sick dog, but it was part of the package. As you can see it is low. What does that mean? In a case such as this it means just one thing – sick dog. This would most certainly not be the way to diagnose hypothyroidism in a dog.

Further reading: Euthyroid Sick Syndrome in Dogs: When Is Hypothyroidism not Hypothyroidism?

Bilirubin

Cookie’s bilirubin was elevated.

Bilirubin is a yellow colored pigment that is a waste product of normal breakdown of red blood cells. It is processed by the liver. Elevated blood levels indicate either an unhappy liver, obstruction of the biliary system or red blood cell damage.

Liver enzymes

Alanine aminotransferase (ALT) is one of the liver enzymes. Elevated ALT also indicates an unhappy liver. However, it doesn’t automatically mean permanent liver damage has occurred, and it does not really reflect liver function. The liver can get angry for a number of reasons. Pancreatitis is one of the reasons for ALT levels to rise.

Further reading: What’s In The Blood? Blood Testing And Interpretation

Other values of note

Cookie’s blood text also showed low globulin and lymphocytes.

According to our vet this is a result of immune response to the inflammation. Such changes can also happen as a result of a stress response (particularly low lymphocyte count). Our vet felt these abnormalities were not clinically significant.

A setback?

Cookie has recovered and everything was well. We were transitioning her to a normal diet very carefully and she was doing great.

Until about a month later when Cookie had another belly upset.

She spent the day at the farm, as always. Had a great time and everything was well. When she came home, though, I knew something wasn’t right just from the way she walked through the door.

Refusing food again

Just not as bouncy as normally, going to lay down right away … don’t ask me how I see the difference, I just do. Then I offered her lunch and she didn’t want it. Now I was really worried.

Hubby, of course, trying to calm me down, suggested that perhaps she was tired.

Like we didn’t have the exact same conversation a month ago … He means well and always tries to look at the bright side. Me, I’m a worrier.

I was watching Cookie as a hawk. She didn’t look as bummed out as last time. She also didn’t mind offering her belly for rubs. Those were positive signs.

Then she refused her dinner too, though.

Hubby asked whether we should try tempting her with something more attractive, but I wanted to listen to what she was saying. She didn’t want to eat so it would probably be best to leave the belly empty. Particularly if this was another bout of pancreatitis.

Meanwhile, she started looking almost normal, alert, interested and following everybody around. Another positive sign.

Cookie vomits

After a potty break, though, she threw up.

Mostly watery, yellow-tinted, with a bit of foam. Another red flag. Were we looking at another pancreatitis event after all? If she was going to throw up again, it would had been time to take her to the emergency vet.

I found out that the onset of pancreatitis can happen anywhere 2 to 36 hours from the trigger. That didn’t give us much to go on. Unlike the last time, there wasn’t anything we were aware that we could point at as a culprit. Other than some stress she went through in the morning.

Stress involvement?

Stress can play a role.

It was after the thaw and freezing rain. Hubby was going to take them to the farm but it looked like there might be a bunch of ice on the way to the truck.

The idea was that he would take JD first, check it out and sand what needs to be sanded and then come back for Cookie. Cookie, however, knew it was a farm trip day. And the guys left without her! She was VERY upset. Even though hubby came back for her as soon as he could, she was quite inconsolable until then. Could that have done it?

We decided to give her one Zantac to see whether it might do any good.

She went to sleep and slept through the night. There was no further vomiting and no diarrhea.

Fortunately, a false alarm

In the morning she woke up bright-eyed, bushy-tailed and hungry.

Technically, she should have been off food because she threw up the night before. As I was watching her, though, I gave it a lot of thought and decided to go with what she was telling me once again and gave her a little breakfast.

And just like that, from the morning on, everything was fine again.

Could it have been pancreatitis that resolved so quickly? I wasn’t feeling it and when I got hold of our vet, he didn’t seem to think so either. Something else then … but what?

When Cookie did go potty, her stool was also perfectly normal too. Yay.

Was this all just some kind of a “blip?”

The fact is, that if it wasn’t for pancreatitis, she had a month ago, I would have been confident believing it WAS just some kind of a “blip.” Major events do change the way one views things.

In closing

I am happy to say that Cookie has returned to normal diet and had no pancreatitis relapse since. She does get the odd stomach upset but just the garden-variety kind.

I continue to watch her fat intake even though fat was likely not involved in her case. Better safe than sorry.