Tag: canine diabetes

Oh Beignet, URINE Trouble now!

So back in 2018 when Dr. Brad suggested I start a blog to help other parents of diabetic dogs, it quickly morphed into way more than diabetes. Beignet sure has comquered a lot! But today I actually have dog diabetes advice instead of my typical Facebook posts! It’s been awhile since I’ve done an actual blog. For those that don’t follow us on Facebook, we lost Beignet’s non-diabetic doxie sister, Andouille Sausage, very suddenly to extremely aggressive renal failure at age 15 on 11/28/21. We are still heartbroken and the tears are still falling. She was truly one of a kind. In March, I saw a 15yo dachshund up for adoption and my broken heart could not handle the fact that anyone could give away their 15yo doxie. Étoufée Rae joined our family and will be shown love and be extremely well cared for all the rest of her days. She’s deaf, heart worm positive and now we know has resistant urinary issues. So that’s a brief update and now back to today’s topic.

Étoufée Rae’s first day meeting Beignet.

I’ve said this before, but I always recommend keeping dog urinalysis strips at home. They’ve saved me time, money and visits to the vet/ER vet. For me, I typically only use them when I find a urine sample on the floor thats not on one of our washable pads. If Beignet’s sick or has a UTI, she has accidents – if she’s fine she almost always goes outside or if not she goes on a pad. So I test the floor sample (not the best sample medically speaking) by just dipping the strip into the puddle😬. I am in the medical field and realize I could buy pipettes etc but this just gives me a quicky view and is not being used diagnostically.

When interpreting results, having more than 1 doxie, seeing whether or not it contains glucose tells me “Who’s guilty.” My nondiabetic should be glucose free – although I’m probably not the only diabetic dog owner who checks the blood sugar of their other pets if they are ever acting abnormal…. If there’s blood, nitrites, or leukocytes – I’m worried about a UTI. I do keep an eye on her protein since that gives me an idea of renal function. I would always let my vet know if I saw more than trace protein because he might want to do bloodwork if there was no known kidney disease. For diabetics, checking for ketones is also important. High blood sugar with ketones = diabetic ketoacidosis (DKA) which is a medical emergency!

Now, if my strip says UTI – for sure the vet or vet will be repeating their own (“clean”) urinalysis sample. No one should expect not to pay for a vet urinalysis because they did one at home. Your vet also may want to send a culture and so they need to make sure it was collected appropriately. The savings come in that you didn’t go in for a UTI check when there was no UTI. Or it may help narrow down what needs to be checked if there is an illness. Now if your vet asks you to collect a urine sample at home, that’s different. However even in that scenario, they still may want to do their own urinalysis and you doing your own strip could potentially contaminate the specimen.

Next lesson: CHECK YOUR EXPIRATION DATES!!! So anyone who knows me, knows its been an EXTREMELY rough year. I’m usually one who pays attention to details. Well guess who didn’t pay attention to the expiration on Beignet’s urinalysis strips?? Yep – this girl! Which is why it now makes sense that I had checked Étoufée Rae’s urine twice with normal results so was shocked to hear she had such bad urinary issues. I’ve been just beating myself up with the realization that she came to me with a UTI and I did nothing. Looks like I got off track (not surprising if you know me)…. Ok so this morning, I found a “puddle.” I tested it and my strip wasn’t doing much. So I know for sure Etta Rae has issues and I know for sure Bennie’s going to have glucose in her urine. Something was definitely wrong. Yep – strips EXPIRED😭. Also in case you didn’t know, strips may not work as well once opened. Be sure to close the container quickly whenever getting a strip out.

I ordered new strips today that should arrive soon. The nerd in me is very excited about my new ones. They are Vet-14’s so they test for 14 different things instead of 10. Link to what I purchased from Amazon below. 

INVBIO-Pet Urine Test Strips 14 Parameter for Dogs & Cats-Urinalysis 14-in-1 Include Calcium Testing- 50 Count https://a.co/d/jaltera
Screenshot from Amazon link posted above

You will have those times when someone will not care that you’ve already diagnosed your diabetic with a UTI before arrival. Beignet’s been diabetic for over 4.5 years at this point. She also has chronic pancreatitis, jejunal IBD, she’s allergic to everything, she has severe dry eye that required parotid gland transposition surgery, etc. I know my dog. We have been through a lot together. I know how she acts when she’s sick with certain things. I can pretty much tell you what her blood sugar is at any time without checking it. Beignet is also as Dr. Brad’s dad used to say, “a true wienie.” She is all drama when she hurts or doesn’t feel good. And of course we all know, her drama is often more than understandable. Anyways, if she has a UTI between my fear of it getting worse with her medical history as well as my work schedule, I go ahead and take her right on to the ER for treatment if its after hours. To me, waiting could mean worsening blood sugars, possible DKA, etc. I like that Bennie has always been so well controlled and we want to stay that way. Well during the pandemic we had one of those experiences. You had to stay in your car at the ER. I told the tech she had a UTI. She tells me she needs a full work-up because I don’t understand the seriousness of the situation. She wants me to agree to labs. I ask to speak to the vet when she seems to think I’m a bad pet owner when I try to explain whats going on. The vet calls and basically tells me I’m gonna kill her if I don’t do the expensive blood work she wants to do. So I sit out there waiting for an update. After such a vehement push towards this work up part of you even starts to wonder, “Am I wrong?” The phone call from the vet eventually comes. She says all the bloodwork was completely NORMAL so she went ahead and did the urinalysis I wanted and she has a UTI. Shocker! Now don’t get me wrong, normally we love the ER vet – theres no place you have a perfect experience every time. Bennie loves most of the crew there. And they may have had a bad night or that vet is just so used to diabetics who’s owners don’t know them so well. But when I already spend so much on my little trouble maker, I was not happy I was bullied into that extra 💵.

Its tough having a special needs dog, because we all end up in those scenarios. When a veterinarian says if you don’t do what they say, you could lose your dog. You know in your heart they are wrong, because they don’t know your dog, your dog’s history, etc, How do y’all handle those kind of situations where you know for sure without a doubt you’re right? Now this isn’t the same as a situation where you just want to be right because you don’t like what they have to say (we’ve all been there too, I’m sure). Also besides home checking blood sugars and doing home checks with dog urinalysis strips – what other ways do you save money with your diabetics?

Well that’s a lot for today. Hope your diabetics are all doing well!

Beignet visiting Dr. Brad this week. She was so brave! The Tooth Fairy came to visit her the next day! She can’t do anesthesia. I do her dentals at home, but can’t pull teeth. She lost her 1st adult tooth. Dr. Brad gave her lots of tummy rubs after and she was a very happy girl.

Diabetes or Livabetes

Y’all I’m so frustrated with veterinary medicine. If your pet has diabetes, they are screwed if they have anything else. In the human world, diabetes is not a death sentence. In the vet world on the other hand… With 1 in 100 dogs being diagnosed with diabetes these days, it should be a significant focus in veterinary medicine. However, research on diabetics with other illnesses is in my opinion absolutely pathetic. My dog has treatable conditions – but in the vet world they are not treatable because of diabetes?? I’m not a vet. I’m tired of researching. Frankly in general I’m exhausted. I appreciate so much my vet trying so hard to research options but why aren’t there treatment plans? No one would accept common human illnesses with no treatment plans. Why is it okay to just put a dog down that could live a happy life?

Meanwhile I’m stuck handling this solo. No advice or help getting her to eat but told to keep going. I’m so confused on what I’m supposed to be doing. On the other hand I’m also over hearing “but it’s just a dog.” Over the fact that I know 100% that if I had a patient with these conditions they would have treatment options. I’m over sitting at home crying. I doubt the pentoxifylline trial will do anything. I’m feeling completely defeated and alone.

Do I give up? Do I travel to a specialist again? I know in my heart that it’s not time yet – she’s not ready to go but I refuse to sit back and do nothing. She’s far too precious and doesn’t deserve to ever suffer.

So I will keep helping her eat for now and making sure she knows how much she’s loved. And in the meantime I don’t want to hear that I’m crazy. That she’s just a dog. Or that I’ve already done too much. For all I know she’s sick right now because of the cracked molar she’s had since diabetes diagnosis that can’t be fixed because she’s a diabetic. I mean how crazy is it that diabetic dogs get refused by vet dentists because they are diabetic? I truly will never recover from the insanity that I’ve learned about the vet world. And I will never understand that people so easily put down dogs that have very treatable conditions. My pets are family and couldn’t be more loved.

~Beignet’s Mom

Holidays & Hypoglycemia

When you have a diabetic dog, you definitely have to be flexible with your schedule. This afternoon, I missed out on Memorial Day with my family because Beignet’s blood sugar was too low.

I feel like hypoglycemia is one of the biggest fears of a diabetic dog owner. The best advice I can give is to stay calm. I always double check a low reading to ensure it wasn’t just a faulty reading. If your dog is symptomatic, quickly rub ~1tsp of Karo Syrup (or honey) directly on his/her gums to get the sugar quickly absorbed in their system. Know this will quickly wear off, so try to get the dog to eat right after. If you have to go to the vet, be sure and bring Karo with you for the drive in case they drop again. Continue to check blood sugars every 10-15 minutes to ensure it’s coming back up.

Beignet has only been symptomatically hypoglycemic one time – at the time I was rushing her to the ER Vet in hypovolemic shock. Needless to say she truly needed Karo Syrup that time (and more than once). Usually if her sugar is low she is not symptomatic. With her other health conditions, she doesn’t do well with sharp rises/drops in sugar. She can’t eat any of the recommended treats for hypoglycemia either which is frustrating to treat hypoglycemia with protein. I’ve had to learn how she reacts so now I feel very comfortable when she does have a low. My vet and I have discussed at length how I should respond.

If your dog does get low & your vets office isn’t open, an absolutely phenomenal resource is the Facebook group Canine Diabetes Support & Information. Someone will jump on your post and help you right away. CDSI is the largest online group and definitely the most helpful. Had some odd experiences trying out other groups and would only trust info from the CDSI group. In fact, I’m not sure I would be able to check Bennie’s blood sugar at all were it not for a member in CDSI that insisted I try checking her inner lip. Total game changer! The other benefit is you get to find support from other pet owners experiencing your same highs and lows. They have great resources available. Plus they will help you handle hypoglycemia step by step if needed.

Know with hypoglycemia a dose change in your dog’s insulin could be needed. Be sure and make a hypoglycemia plan with your vet and if that’s not possible, use the CDSI resources.

Well I better run and get Beignet fed. Hopefully she will eat after all of her treats earlier… Hope everyone had a wonderful Memorial Day! We are so thankful all who have served our great Nation!

Sincerely,

Devoted Doxie Mom

Click on products below to start testing your dog’s blood sugar today!

Tales of a Hangry Dachshund

The look you get when you force your dog to try nasty vegetarian dog food…

Does anyone else have as many feeding issues as we do? I’m not sure even our vet team truly understands the time and energy I spend each day trying to get Beignet to eat. Mistake #1 is that both dogs free fed prior to the diabetes diagnosis. Definitely would never ever make that mistake with any future pets in the off chance we ended up right back here. So after diagnosis I had to add toppers and such to get Bennie to eat on schedule. When she became very ill 5-6 weeks post diagnosis, she had to be syringe fed about 4 times a day for weeks. After she recovered to this day she will not touch wet dog food, a previous favorite. She also doesn’t like to eat out of anything except her regular metal dog bowl.

Those are the easy things we’ve dealt with. The biggies are knowing she also has jejunal inflammatory bowel disease and chronic pancreatitis. Pancreatitis requires a low fat diet. IBD requires a novel protein or hydrolyzed protein diet. Not only do I have to ensure Bennie never gets into anything that could increase her blood sugar but now she’s so extremely restricted in what she can actually eat.

One thing I’ve learned is that there are almost no dog foods she can safely eat. Nor does any company specifically make a food for a dog with all of her conditions combined. Hydrolyzed protein foods are generally far too high in fat for her to eat. Because of the minimal options, vets are not comfortable making changes.

One thing I learned is that you can’t go by the fat percents on dog food bags. You have to calculate the dry matter fat percent using an online calculator (Ex: https://www.pawdiet.com/articles/dry-matter-basis-calculator-for-pet-food/). I now because of our ordeal have quite an extensive lists of foods I have calculated on my own so that I never deal with someone recommending a food she cannot have. https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3Ac9264731-8e11-4cbf-956f-413d835e9027

One of the most shocking issues we’ve had is that we traveled 4.5 hours to College Station for Beignet to be hospitalized with the Internal Medicine team at Texas A&M Vet School. My understanding is they are one of the nation’s leaders in gastrointestinal disorders. They insisted she should be on Royal Canin Hydrolyzed Protein dog food because it was the lowest dry matter fat food of any hydrolyzed food. We returned to Louisiana and Beignet’s blood sugars were rising higher than they had been and she continued not to feel well. Imagine my surprise when I calculated the dry matter fat percentage and discovered she was now on the HIGHEST amount of fat in a hydrolyzed. I called and the staff doctor was shocked by my revelation. She admitted they had never calculated the fat content themselves because the Royal Canin rep assured them it was the best food in dogs like Beignet. WHAT??? Apparently to this day Royal Canin falsely markets many foods to busy veterinarians that don’t take the time to do their own research. This should be illegal! They admitted to me this was not the food for my dog when I called to complain. I did my own research and had Beignet put on Purina ProPlan Veterinary Diet HA – the actual lowest fat hydrolyzed protein food after a failed attempt with Rayne Clinical Nutrition Low Fat Kangaroo food. After a few months on the Purina, Beignet’s hair finally grew back where they had shaved her stomach and she quit having flares. Problem is she hates the food. It reminds me of Kix cereal. Our vet had me start ordering grass fed ground bison to use as a topper (not sold locally so has to be shipped in since only vegetarian fed is available). Needless to say I’m completely over the feeding expenses I incur for food my dog hates.

I have to try trick after trick to get Bennie to eat so we can give her insulin. I shocked myself recently. After I removed all of my pets from Royal Canin last year (they lost a lifetime customer that’s for sure), I was willing to try just to see if it would work. Tonight was our first attempt with Royal Canin Vegetarian food – the only food I felt like she might tolerate fat-wise. My friend Heather had mentioned how much her dog Izzy had liked it. Well not so much with Beignet. She did sniff it as seen below but that was it. Back to square 1 I guess… Thank goodness she likes the bison as well as her absolute favorite treat, RooBark, 100% kangaroo jerky. I think she’d live off Roo Bark if I’d let her.

Click Above To Purchase Beignet’s Favorite Treat!

I truly believe one day I will find the right food that she will love without having to doctor it up. If anyone has any advice feel free to comment below. Or if you just need to commiserate over your own struggles.

Sometimes I wonder just which one of us is not going to survive all this! I sure hope she knows how much she’s loved!

Sincerely,

Devoted Doxie Mom

What a cool idea!  You can click on the pic above to get a dog food bowl with a built in scale!  That way you know exactly how much your dog ate!

February Flashback

Last February started weeks of 1 sick little doxie. I hope today doesn’t mark a repeat for sweet Beignet. As we were actually prepping to resume our blog to help others with diabetic dog care, Bennie decided to get sick instead. This will be her first real flare up of pancreatitis/IBD since June. Gone are the days I made sure I was stocked with Cerenia – thank goodness I found some in her med drawer – I’m definitely out of practice! I did stop her 3 time a day metoclopramide a couple of weeks ago. She hasn’t had an issue until today, but maybe that’s the cause…

I decided to go ahead & make a post today though to let others know just how helpful it is when you check your diabetic’s blood sugar. Without having this information, likely I’d be spending a fortune in the ER today because it wouldn’t be safe to have her home not knowing what her blood sugar was while ill. Checking blood sugars isn’t hard. Also with new technology like the Freestyle Libre, checking blood sugars may become even easier. With that said I have not personally used the Freestyle Libre & cannot verify its accuracy in pets (https://www.freestylelibre.us). So our blog today is to encourage all our diabetic dog owners to home test if they aren’t already. If you are please comment with your favorite testing site and favorite meter!

Ironically our local ER vet has Bennie as the face of pancreatitis on their video of emergent pet conditions. 🤞🏻 they don’t get to see their pancreatitis superstar and we can stay home!!! 🙏🏻🙏🏻

Thanks for reading and I promise to get more posts up soon!

~Devoted Doxie Mom

We Love Our Vet Crew!!!

Bennie snuggling with her favorite human, Dr. Brad Everson, during a recent visit.

When you get a life changing diagnosis like diabetes, initially you may be in a fog of sorts. Even as a (human) medical professional, the thought of taking care of a diabetic pet was unfathomable – there are so many differences between the care of humans and animals. Knowing you have an AMAZING vet to get you through this journey is key! Long before her diagnosis, Beignet formed a special bond with her vet, Dr. Brad Everson at Southern Hills Animal Hospital in Shreveport, LA ( http://www.sohillsvet.com ). She gets so incredibly excited when she realizes we’ve pulled up. She adores everyone on staff, but no one quite as much as her Dr. Brad. The joke amongst the staff is that Dr. Brad is her boyfriend😂. She will literally sneak out of an exam room to look for him in his private office if she doesn’t see or hear him. She will cry and moan if she hears him in the next room, completely jealous he’s in a room without her.

Bennie has spent quite a bit of time at Southern Hills since her diagnosis in January 2018. Even at her sickest, she is always happy to be there. If she spends the day, I don’t even get so much as a tail wag because she is never ready to leave. From the moment she walks in the door she has everyone from receptionists to everyone in the back, ready to give her tummy rubs. She’s also good at getting everyone in the waiting room to rub her tummy as well. We just can’t say enough about how much we love our vet team!!!

When it comes to having a diabetic pet, you need to think of yourself as part of a TEAM with your vet. Hopefully everyone has a vet like, Dr. Brad, that they can work seamlessly with. He is always patient, answering the LISTS of questions I bring in each visit. He encouraged me to home test, letting me know Bennie would be hopefully regulated far quicker and more accurately if I was willing to home test. Having had several diabetic pets himself, he empathized with our set feeding and insulin schedules. He has time and time again gone above and beyond for my sweet girl. He truly loves her as much as she loves him. He is typically on the floor rubbing her tummy or holding her while she showers him in doggy kisses while he fills me in on everything I need to know.

My advice for anyone going through this is to have a vet you can trust and work with. Don’t make changes to your pet’s care without consulting your vet. If you want to change insulin or other medications, discuss these changes with your vet as they may have reasons for the medications they have prescribed for your pet. Be patient. Your dog will not be regulated in days or weeks. If you don’t feel you are getting correct information get a second opinion or request to see an Internal Medicine specialist veterinarian. This may require you to travel. However, they typically will allow you to send them home testing results and blood glucose curves and give you advice between visits via phone or email. Plus I think the goal of most vets and vet specialists is to get you to the point that you are comfortable making your own insulin changes, etc if you home test. If you don’t home test, your vet will always manage your dosing based on your dog’s blood sugars in their office. Thankfully if needed, Southern Hills has an Internal Medicine Specialist, Dr Treadwell, on staff if we were to need her.

Just wanted to post this Ode to Dr. Brad! I can’t even list the ways he has gone over and above for us! He actually told me when Bennie was just 2yo that he suspected she would end up having IBD when she got older, so at least I was somewhat prepared for that diagnosis. We ❤️ the Southern Hills team and the quality of care we always know we will get! When my dogs went for their ProHeart shots, Dr. Brad’s newest partner, Dr. Tori Torres, saw us. She had taken the time to review Beignet’s whole chart when she saw us on her schedule so she would be up to date and prepared for any questions I might have on Bennie’s care which really impressed me! Another partner, Dr. Brown, discovered Bennie’s dry eye diagnosis. So thankful for our Southern Hills crew!! The best of the best!!!

-Devoted Doxie Mom

Bennie with Ms. Bonnie that runs the kennel area at Southern Hills. Bonnie always makes sure my diva gets extra spoiled on all the days she is sick enough to spend the day with Dr. Brad. And she always comes to our exam room to get her snuggles if we are just in for a quick visit. Bennie trying to tell Ashley to rub her tummy instead of posing for yet another pic.Bennie giving kisses to LJ, one of her many besties at Southern Hills.

Making sure she gives everyone a turn to give her some love!

Beignet does NOT like sharing snuggles with Andouille!

An Eye For An Eye….

Pictured above is our 3rd vet specialist selfie of 2018. Beignet and I just made our first 6 hour round trip visit to see Dr. John Warren at Veterinary Eye Institute in Plano, Texas (http://www.veterinaryeyeinstitute.com/meet-our-doctors/john-r-warren/ ). When Beignet got diagnosed with diabetes, all I could focus on was that she was only 7 years old and could soon be blind due to this diagnosis. Was she going to be able to beat diabetes? Of course I just assumed as a physician she would be the best controlled diabetic my vet has ever seen (and yes Bennie decided that wasn’t going to be the case…). Was her perfect control going to be soon enough to prevent diabetic cataracts? I sure hoped so.

The doctor in me immediately thought I needed to do all the preventative precautions for a diabetic. However we had a few obstacles. First there are very few vet specialists in our area. Secondly, Beignet threw me a major ball when she became extremely ill just weeks after her diagnosis. Worries over her eyes after a 6 week struggle for her life were just a distant memory.

Dr. Warren said it is always best to see a vet ophtho as soon as possible after a diabetes diagnosis. They can guide you through what to expect. Work with you on preventative care options. And also diagnose cataracts and other eye conditions that may already be present. Depending on the source, 50-70% of dogs diagnosed with diabetes develop cataracts during the first year after their diagnosis. Beignet has 4 more months until her 1 year anniversary so we hope that we beat those odds. However all diabetics will eventually get cataracts. My almost 12yo nondiabetic has early lenticular cataracts from old age now. My understanding is that diabetic cataracts respond better to surgery than nondiabetic cataracts, so at least there’s that if I can afford surgery when our time comes.

What I didn’t realize with my focus on cataracts was the next most common eye disorder in diabetics, Keratoconjunctivitis Sicca (aka dry eye). After a bout with corneal ulcers, Beignet received this new diagnosis weeks ago. Having the same diagnosis, I have some idea of what she’s been going through. However my dry eye doesn’t involved nasty snot pouring from my eyes all the time (thankfully). Beignet can at times not open her eyes. She blinks repetitively. I’m constantly having to clean her eyes and apply drops. If your diabetic dog has mucus discharge of any color from his/her eyes, please have your dog tested for dry eyes or better yet, see a vet eye doctor if you haven’t already. When Beignet saw Dr. Warren, she still had ZERO tear production in either eye. She has to do a month of once daily steroid drops along with a compounded 3 time a day immmunosuppressant drop that will hopefully stimulate tear production. If dogs fail therapy they can transplant a saliva gland from the mouth to the eye which causes nonstop tearing. We hope we don’t have to resort to this….

We will be traveling back to see Dr. Warren in a month. Please pray that her eyes are responding to treatment. We are feeling a little defeated at the moment. I keep thinking – what next?? Before 2018, we had minimal issues. So far, it’s been diabetes followed by chronic pancreatitis followed by suspected jejunal inflammatory bowel disease followed by a new heart murmur and now this. You can see with all that, why we aren’t the perfectly controlled diabetic I initially thought she would be (although is there even such a thing???). Her eye issues require more time than anything else. And for the record her heart issue was insignificant. Despite it all except for the 6 weeks in February/March and this past month this sweet baby has been nothing but happy no matter what she had to deal with. I’m hoping we get back to that fun loving, tummy rub obsessed, tail wagging, loves everyone happy girl again!

To end, my advice is even if you have to drive, get your dogs eyes checked! Even if you can’t afford cataract surgery, getting established might improve you dog’s long term outcomes. And what if your dog has treatable dry eye, like Bennie or another easily treatable condition? Not treating can lead to vision loss. I definitely don’t think a $125 visit was at all unreasonable especially in that it was the nicest vet office I’ve ever visited. Just wish he was a little closer!!!

~Devoted Doxie Mom

Addendum : A lot of diabetic dog owners go ahead and start lubricant eye drops when their dog is diagnosed to hopefully prevent their dog from getting dry and becoming more susceptible to corneal ulcers. Here is the type many use pictured above. Click on the pic to purchase.

Although it was recommended that Beignet not use just drops.   Instead, Dr. Warren insisted she use the GenTeal Tears Severe Gel (not to be confused with the version for nighttime that’s a step up from this which we were told not to use). You can purchase the gel by clicking on the pic ABOVE

There is no set brand of eye wash you have to use. It’s best to use a dog version of an eye rinse though or sterile water whereas the GenTeal brand of dry eye products are actually made for humans but okay to use on pets. I’ve posted a link to our favorite sterile eye wash below. Click on the pic to purchase.

Should We Be Enticed by Entyce??

Anyone else ever had to offer their diabetic a literal buffet to try to entice them to eat in order to get that all too important insulin injection done??? For Beignet, add in the diagnoses of chronic pancreatitis and suspected jejunal Inflammatory Bowel Disease (IBD). If we have a flare of either, then meal time becomes an absolute nightmare🤯🤦‍♀️😭! When Bennie was hospitalized with the internal medicine service at Texas A&M Vet school, I was told to offer her different wet and dry options until she hopefully decided to eat something. That plan doesn’t work for Beignet at all. Thankfully they sent us home with something that did help – the new dog appetite stimulant, Entyce®️ (capromorelin).

When they initially prescribed it, I had questions. I had heard the sugar content was high and that it could potentially interfere with insulin. I’m not sure if it has now been studied in diabetics, but it had not been back in March. Our vet team listened to my questions and concerns, and said that I was absolutely correct in that its use is currently controversial. However, they said it was far more important that Beignet start eating (she had been very ill for ~4 weeks at this point) and that she would only be on the medication once daily for 4 days. So basically in the grand scheme of things, potentially having a few days of a higher sugar was a small price to pay if she overall improved. We’ve used Entyce®️ several times since March for flares. I only noticed her blood sugar increasing with our last round back in June. I’ve seen others post that their dogs increase every time. It takes about 1-2 hours for it to kick in on Bennie. So if I don’t know she’s not going to eat, its not as helpful day 1 of a flare if I want her to remain on her regular insulin schedule. I personally wouldn’t use this for the overly picky diabetic, but more for illnesses like pancreatitis and IBD. If your dog is in the latter category, its something you can potentially discuss with your vet. Since it is new, many vets are not using just yet. Our vet said we should always have Entyce®️ and Cerenia®️ on hand in case of a flare. We spilled some of our prescription from Texas A&M, so Dr. Brad ordered us a new bottle which was the first prescription they had dispensed from Southern Hills Animal Hospital (although they have used it on hospitalized patients with great results). Just sharing this to reiterate that this is a new product with a lot of promise for our diabetics with pancreatitis and/or IBD, but is something you may have to do a risk/benefit discussion with your dog’s vet if needed. Since we had some on hand, he had me give a one time dose to Andouille, my other dachshund, who refused to eat after having a procedure under anesthesia. It worked great for her as well! Hope this info helps since I left out info on Entyce®️ on my pancreatitis post!!

-Devoted Doxie Mom

The Panic of Pancreatitis

Is there anyone who’s heard ‘pancreatitis’ and not freaked out a little? And if you didn’t freak out, maybe its because you truly just didn’t know much about it. I will review what pancreatitis is, how its diagnosed, how its treated, the prognosis, how to prevent pancreatitis and our personal pancreatitis journey with not 1 but 2 doxies.

First you might be wondering what your dog’s pancreas has to do with diabetes. The pancreas is an organ that has both endocrine (think insulin production) and exocrine (think digestive enzymes for fat and protein breakdown) functions. So since the pancreas has endocrine functions it is most definitely involved in diabetes. Pancreatitis can be acute or chronic. It can be mild or subclinical, it can also be severe. Pancreatitis can cause diabetes. Its also said that diabetes can cause pancreatitis.

Here’s a little breakdown of how pancreatitis happens: Pancreatic ‘juices’ get secreted ➡️ Other enzymes get activated ➡️ Damage to the exocrine pancreas occurs (Ex. Bleeding, swelling, inflammation, breakdown including fat breakdown, etc) ➡️ The body mounts an inflammatory response ➡️ Enzymes and inflammatory substances spread throughout the body ➡️ General inflammation spreads throughout the body affecting multiple organs. So with all this potentially going on, you can see how even just one episode of pancreatitis could cause permanent changes to your dog’s pancreas.

SYMPTOMS of pancreatitis can be vomiting, anorexia/hyporexia (not eating at all versus decreased appetite), dehydration, fatigue, weakness, pain, depression, diarrhea, fever, high heart rate, breathing difficulties, shock, etc. My non-diabetic dachshund was diagnosed with pancreatitis years ago and her only symptom was that she wasn’t sleeping well. She was constantly up and down, because she was unable to get comfortable due to pain.

You may never know the CAUSE of your dog’s pancreatitis. Many cases are idiopathic, or cause unknown. Here are some potential causes:

    Diet and nutrition are important triggers. Generally this is a high fat/low protein diet. There are typically an increase in cases around the holidays when dogs tend to get into table food they shouldn’t. Always ensure your dog can’t get to food or your trash! It can happen with just one ‘meal’ of fatty table scraps. Also certain prescription diets such as those that help dissolve bladder stones.
    Hypertriglyceridemia is when there is excess fats circulating in the dog’s blood (typically >500mg/dL).
    Trauma
    Hyperadrenocorticism
    Obesity
    Surgery – although this is now thought to be caused by decreased perfusion to the pancreas during anesthesia
    Drugs/Toxins
    Infections
    Hypercalcemia
    Associated illnesses

Any dog can be affected by pancreatitis. It is more common in middle aged to elderly dogs. It is more common in females. Research from necropsies are beginning to show far more dogs are affected than anyone originally thought. Certain breeds are known to be more predisposed to pancreatitis. Those include: Schnauzers, Poodles, Cocker Spaniels, Yorkshire Terriers, Dachshunds, etc.

DIAGNOSING pancreatitis whether acute or chronic can be very tricky! I was shocked to discover Beignet had chronic pancreatitis. How could I have not known she had it??? In humans, lipase and amylase elevations typically give you your diagnosis but do not determine severity of disease. Amylase shows elevations within 5-8 hours of symptom onset and returns to normal by day 3-4 and reaches a maximum 12-72 hours after symptom onset. Some research supports only checking lipase in humans due to it being elevated both in the early and late stage. Lipase elevates within 4-8 hours of symptom onset, peaks at 24 hours and returns to normal within 8-14 hours. In humans, both amylase and lipase can also increase with other disorders. I feel its important to understand a little about human diagnosis to help us understand dog diagnosis. Below I will go through each diagnostic option in dogs:

  • CBC & Chemistry Profile: These are extremely important to evaluate the dog for systemic complications, but are NOT useful to diagnose pancreatitis. In a dog with pancreatitis, you may commonly find signs suggestive of nonspecific inflammation, a decrease in platelet count, an increase in neutrophils with a left shift, increased BUN and creatinine, increased liver enzymes, increased bilirubin, etc. Although amylase and lipase are on the Chem profile, they are described below.
  • Amylase: Has very poor sensitivity and specificity. Very limited as a measure of pancreatitis diagnosis. Possibly given the human info above, its already potentially normalized by the time the dog presents to their vet.
  • Lipase: This is generally on most in-office metabolic panels. Lipases are something released from multiple organs including the pancreas, liver, stomach, endothelium etc). A serum total lipase is NOT specific for pancreatitis. An article online from Texas A&M Vet School said it could miss up to 86.4% of pancreatitis patients. Lipase can be increased by steroids, cancer as well as diseases of the kidney, GI tract, and liver. Also there is an increase in false negatives in pancreatitis patients due to hemolysis, lipemia and icterus (jaundice). Beignet has never had an elevated amylase or lipase.
  • Serum Pancreatic Lipase Immunoreactivity (PLI): The Spec cPL®️ specifically tests for pancreatic lipase and has rare false positives. In office rapid cPL tests are available, but generally cPL tests are send out tests for most vets. This test is how we got Beignet’s diagnosis of chronic pancreatitis. http://vetmed.tamu.edu/gilab/service/assays/pli. Be aware that many GI conditions can cause mild pancreatic inflammation. This in turn can increase your cPL test. Sometimes a repeat cPL maybe needed to help determine if the dog has a primary or secondary pancreatitis.
  • Trypsin-like Immunoreactivity (TLI): This is the diagnostic test of choice for EPI as it tests exocrine pancreas function. It is not very sensitive for pancreatitis though.
  • Abdominal X-ray: This is more important to help excluse other diagnoses in your vet’s differential diagnosis (the diagnoses your vet is ruling in or out including pancreatitis). Findings in pancreatitis will be nonspecific.
  • Abdominal CT or MRI: Very insensitive in cats and never truly evaluated in dogs. Probably not worth what this would cost you.
  • Abdominal Ultrasound: Highly specific for pancreatitis, but just seeing an enlarged pancreas with fluid accumulation around it is not enough to give you the diagnosis. With newer high resolution ultrasounds, occasionally pancreatic nodular hyperplasia could be misinterpreted as pancreatitis. When it comes to an ultrasound, consider the expertise of the ultrasonographer (who maybe your vet), quality of the machine, and the level of suspicion of your ultrasonographer. When Beignet was sick, my vet told me his ultrasound machine was older and if we wanted to do one locally, he would send us to do one on a better machine. We were going to a vet school, and chose to wait to do one there done by their radiologist. I was able to see chronic changes quite easily on the entire left side of Bennie’s pancreas on her ultrasound😢. Contrast enhanced ultrasounds have improved diagnostic evaluations but aren’t routinely done.
  • Pancreatic Cytology or Histopathology: This can give you a definitive diagnosis. FNA (fine needle aspiration) of the pancreas has been reported to be safe. But sometimes the disease is very localized, so a normal FNA does not exclude pancreatitis. Biopsy on the other hand can increase a dog’s risk of pancreatitis as compared to FNA. If pancreatitis is severe, a dog’s anesthesia risk is much greater. An exploratory lap or FNA may be too risky in severe pancreatitis.

If your dog has joined us in the pancreatitis club, you maybe curious about TREATMENT options:

  • Aggressive fluid treatments with electrolyte replacements if needed.
  • Remove any potential causes.
  • +/- Gut rest. Recommendations on this vary. Definitely will be done if the dog is vomiting despite anti-nausea medications. Beignet required it.
  • Nausea medications: Cerenia and ondansetron are potential options
  • Pain medications
  • +/- Antibiotics: these have questionable value so are not routinely recommended.
  • Reglan (metoclopramide) for improving gastric motility. It can help with nausea but should not be used as the dog’s anti-nausea medication in pancreatitis. I read that it could decrease blood flow to the pancreas potentially. Bennie was put on this for gastric emptying and it was increased from twice to three times a day when she was hospitalized at a vet school.
  • Reflux medications. Many dogs are put on them but I haven’t seen them listed as parts of treatment. Bennie was put on omeprazole but advised to stop after a week due to potential issues with long term PPI use. However she may have been put on this more for her suspected IBD than her pancreatitis.
  • Food: May require a permanent food change. Generally <10% dry matter fat, but Ultra Low Fat diets are what we will see being recommended in the future. Stay tuned for an upcoming post with all my dry matter fat calculations. Do not use the fat percent on your dog food label (unless Hill’s, who often has the actual dry matter fat values on their labels) but instead put the information into a calculator like this one http://fnae.org/dmb.html. Know that these values are minimums and typically the food contains ~3% more fat than what you calculate. You can always contact the company to ask for the actual value. Early nutritional support is a key component of successful treatment in humans with pancreatitis.
  • Plasma transfusions maybe needed in severe cases of pancreatitis.
  • If a dog isn’t responding, prednisone, prednisilone, or cyclosporine maybe given. Cyclosporine for a dog with diabetes is preferred as it has less of an impact on insulin resistance. There is not a lot of data on its use in chronic cases.
  • Entyce – a newer appetite stimulant maybe needed to get your dog to eat. Since I forgot to originally add this, I will post about Entyce in an upcoming blog.

To PREVENT pancreatitis, keep your dog at their recommended, ideal weight. Avoid feeding foods high in fat. Work on a weight loss plan for your dog if they are overweight. Discuss any medications your dog is on with your vet to determine if they potentially increase your pet’s risk.

Your dog’s PROGNOSIS depends on the severity of disease. Risk factors for poor outcomes include: hypothermia, acidosis, low calcium and failure of 1 or more organs. Chronic pancreatitis typically has better outcomes, but may eventually cause diabetes (like in Bennie) and/or other diseases that affect the dog’s quality of life. There are many dog’s like Beignet that have an upset tummy here and there, but aren’t very ill. So even with a visit to the vet, no one is aware that the dog is actually having a mild pancreatitis flare. Chronic pancreatitis maybe associated with intestinal or liver inflammation.

This went a little longer than I initially intended. My information is more to give a better understanding of pancreatitis and should not replace the care and advice of your vet team. My information comes from my own personal medical knowledge and reading various articles over the past months. Texas A&M vet school has many great articles on pancreatitis. The Merck Manual online also has some great reading on dog and cat pancreatitis. Hopefully if you experience an acute flare your dog does well! I will tell Bennie’s story in a future post.

-Devoted Doxie Mom