Canine pancreatitis treatment

Re: Canine pancreatitis treatment

Hannah Wynne Richards — Tue, 14 Sep 2010 15:57:11 GMT

Jacquin

I hope the dog is improving, but your comment about fluids costing did give the impression that proper treatment had been offered and declined

Owners who decline the recomended treatment, and then go round town whinging when the animal gets worse are high on my list of pet hates

Wynne

Re: Canine pancreatitis treatment

Nixthevet — Mon, 13 Sep 2010 15:39:24 GMT

In the circumstances, if the vet your friend saw last time did not strongly recommend Iv fluids and analgesia as the best course of treatment, and bearing in mind that this little fella's life is probably in the balance if he's gone down hill again, then I would definitely recommend that your friend takes him elsewhere immediately and not back to the same practice. ( Having called to let them know that she is seeking a second opinion so that they can maybe get his previous blood results etc).

Your friend may need to make a difficult decision on what the best treatment option/s are for this old boy and it does not sound like the vet in question will provide enough informed guidance for your friend to be happy that she is making the right choice in whatever she decides. You mention that it was a low cost vets that she went to but this should not mean that she should have only been given the 'cheap' treatment options.

I hope that the outcome is a good one.

Nichola

Re: Canine pancreatitis treatment

Bob Russell — Mon, 13 Sep 2010 15:34:27 GMT

It is very easy to jump to conclusions on forums so don't panic if wrong conclusions or heated responses are received. Without being there we only have part of the story!!!

Have bloods come back yet? Have other differentials been ruled out?

Pancreatitis can be tricky to diagnose and to treat. We sent a very miserable Westie to one of our referral centres and even after lots more bloods and a very thorough work up the diagnosis of pancreatitis is still ''presumptive''. Fortunately the dog has improved on treatment and is back to normal!!!

My treatment is pain relief, pain relief and then more pain relief!! I use buprenorphine and will send some home with the owner if appropriate to be given by mouth. Our referral centres seem to quite like fentanyl patches but these need good supervision.

I do use NSAI's for mild to moderate discomfort and find it helps.

I have also been guilty of giving them steroids on occasions (not at the same times as NSAI's) - they can improve dramatically.

This is frowned upon by some and considered a complete no-no by others but I went to a talk a few years ago given by a medic from Liverpool University and he was quite supportive of their use.

I/V fluids and antibiotics as appropriate.

The GtoPC is just a guide not a bible. If a vets actions are sensible and considered there should be little risk of falling foul of it.

Re: Canine pancreatitis treatment

Jacquin Mitchell — Mon, 13 Sep 2010 14:00:11 GMT

[quote user="Hannah Wynne Richards"]

I think a lot of people are scared of the bit in the Gto PC which says owners must be offered a range of options-even when a range isn't suitable !!!!!!!!!!!!!!!!!!!!

I think this "friend " would be an ex-friend by now-sounds to me as though they were too mean to pay for hospitalisation, and are now trying to get further advice FOC

Wynne

[/quote]

Sorry, but I do feel I have to reply to this. My friend certainly wasn't too mean to pay for hospitalisation. If that's what the vet in question recommended she would have gone with that.

The dog is her baby and she feels he's got her through some tough times so has never skimped on vet treatment before.

She was told to take the dog home. Fluids were mentioned as an aside but she got the feeling that the vet didn't think it was worth it. The 'It will cost money' comment came from the vet, not her and so she felt she was being told to take him home. If they had said 'this dog needs hospitalisation and fluids' she would have gone with that.

I'm not criticising the vet btw. She went to a low cost clinic where most people probably don't have much money. She's just moved and should have looked at vet clinics before she needed on, so she knew she had one that suited her and her dog.

The old boy has gone down hill again today, so she'll see what they say tonight.

Jacq

Re: Canine pancreatitis treatment

Nixthevet — Mon, 13 Sep 2010 13:41:48 GMT

I agree that the G to PC has a lot of vets- especially new grads terrified. Personally my own moral conscience pervails and I am lucky enough to have always had the backing of my practice principle, or ( as senior vet)my company, to allow me to stand by my morals and sleep soundly at night. That's not to say there haven't been sad cases that I know that I could have saved ( given permission/funds) that have sadly had to be euthanased...but at least the poor little beggars never suffered for lack of treatment or compassion.

Re: Canine pancreatitis treatment

Hannah Wynne Richards — Mon, 13 Sep 2010 13:23:24 GMT

I think a lot of people are scared of the bit in the Gto PC which says owners must be offered a range of options-even when a range isn't suitable !!!!!!!!!!!!!!!!!!!!

I think this "friend " would be an ex-friend by now-sounds to me as though they were too mean to pay for hospitalisation, and are now trying to get further advice FOC

Wynne

Re: Canine pancreatitis treatment

Nixthevet — Mon, 13 Sep 2010 13:05:51 GMT

Isn't it a bit sad that everyone immediately jumped in to criticise the vet for not admitting and starting IV fluids/further treatment.....and yet it turns out that these were offered but declined?!

The use of Metacam is probably inexcusable....but again it depends on whether the owner opted for a palliative approach rather than letting the vet carry out their preferred treatment options. ...there is invariably more to these stories than immediately meets the eye.

Unfortunately it sounds like this may have been one of those very difficult cases where the vet suggested what he/she felt would provide the animal with the best chance of a speedy and pain-free diagnosis/recovery....but had to settle for an alternative approach due to the owners wishes. I would agree with an earlier post that perhaps a firmer approach should have been taken by the vet....i.e. a take him home and see approach should not have been offered in teh circumstances as this dog probably suffered more discomfort than was necessary.

I hope that this little fella is doing ok and is now compfrtable and on the road to a diagnosis and/or recovery.

Re: Canine pancreatitis treatment

Bob Russell — Mon, 13 Sep 2010 11:24:07 GMT

It is very dangerous to criticize a vet so directly as even the best owners are infamous for selective hearing! By the time I have run through the many options available (gold-standard down to bargain-basement) it is hardly surprising that owners can get confused.

If fluids etc were discussed it sounds as if the vet discussed options but it is amazing how much we try to fit in to a 10-15 minute consultation. If the dog was clearly in agony in the consultation room I would not expect any vet to 'bung a plaster' on it and send it home.

Rarely are things black or white just various shades of grey!

Re: Canine pancreatitis treatment

Hannah Wynne Richards — Mon, 13 Sep 2010 10:36:46 GMT

My 1st reaction was "Why on earth wasn't it hospitalised for double rate fluids, and opioids ?"

The answer seems to be "she was told that fluids were an option but they'd cost money "!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

If this poor old dog doesn't make it, it's definitely the owner's fault , not the veterinarians

Wynne

Re: Canine pancreatitis treatment

Jacquin Mitchell — Sun, 12 Sep 2010 14:57:26 GMT

Thanks everyone. The dog seems a lot more comfortable this morning and my friend is happy to wait until tomorrow to have him looked at again. Am thinking maybe his back should be examined more closely this time.

My friend is pretty sensible and would go with what was recommended by the vet she saw. I believe her when she says she was told that fluids were an option but they'd cost money and that the vet wasn't sure about giving metacam as it 'could upset the pancreas?'

Anyhow, hopefully the poor old guy improves, she's going to find someone else before she needs a vet again.

Re: Canine pancreatitis treatment

Martin Jones — Sun, 12 Sep 2010 10:06:18 GMT

Monday evening? Bloody hell, even I'd take a stick to a vet who said that under these circumstances. Hopefully it's one of those he-said-she-said stories which has got muddled in translation. Dog needs help.

Re: Canine pancreatitis treatment

Mark Holmes — Sun, 12 Sep 2010 07:03:03 GMT

I hate being critical about cases from a distance BUT on the face of it Bloody Hell why is this dog at home? Sorry but a dog in distress like this gets two options with me 1) admit and find out what's wrong or 2) euthanased. There is no way this dog has a "wait and see disease". It's a shame Robs gone really if he wanted to criticise analgesia he could gave gone wild with this one.

Re: Canine pancreatitis treatment

Niall Taylor — Sat, 11 Sep 2010 23:17:42 GMT

[quote user="Jacquin Mitchell"]

A friend has just emailed me about her 14 year old Miniature Wirehaired Daschund who is vomiting... they have sent him home with... metacam... He's still in pain and vomiting ...[/quote]

Spot the delibarate mistake...

[quote user="Jacquin Mitchell"]Anyone got any suggestions for how she can help him at home?[/quote]

Take him off the Metacam p'raps.

Also, even if he does turn out to have pancreatitis doesn't mean he doesn't have something else going on aswell, eg. foreign body.

Niall

Re: Canine pancreatitis treatment

Michael Woodhouse — Sat, 11 Sep 2010 22:05:34 GMT

Usually a case of pancreatitis as severe as you are describing gives and increase in lipase and or amylase and would be picked up in house.

I once saw a Dachshund presented similar and ended with a catastropic disc herniation a few days later. Presented as abdominal pain and had me fooled, but adbo palpation must have caused the back to arch.

With the breed and I assume either amylase or lypase done in house and normal I would consider other causes[ in addition]. Sounds like this dog needs more analgesia. I have dispensed Vetergesic to trusted clients for them to inject. Sometimes a single shot of buprenorphine is enough to settle things down and the dog will eat and can go on to oral tramadol. I wouldn't fancy them forcing tablets down a dog that's not eating and is vomiting.

Re: Canine pancreatitis treatment

Jacquin Mitchell — Sat, 11 Sep 2010 21:32:02 GMT

Thanks guys. My immediate thought was iv fluids and more pain relief but I thought I was probably behind the times somewhat. The vet doesn't want to see him again until Monday evening, I'm going to suggest she gets him seen earlier perhaps by someone else in the practice ( She's just moved to the area and went to the closest).

Jacq

Re: Canine pancreatitis treatment

Martin Jones — Sat, 11 Sep 2010 20:39:54 GMT

What Andrew said.

Pain isn't acceptable, and it's a classic weekend condition - he needs to be in on fluids and a bit more investigation.

Let us know how he gets on

Martin

Re: Canine pancreatitis treatment

Aurelijus vet — Sat, 11 Sep 2010 20:35:55 GMT

First.Need to identify the cause.Home environment is difficult to cure dog especially in the case.

I recommend. Anti-emetic Metolcopramid (cerucal) 0.2-0,5 mg/kg bid

Antispasmolitic. Drotaverin (No-spa) 4 mg/kg bid reduce stomach acid Ranitindin(Raniberl) 5mg /kg sid and Omaprezol

for pain relief for him Analgin(Methamyzol natrici) 500mg for the 10-15 kg body weight. Ketoprofen(Ketonal) 1mg/kg bid Intestinal gas reductions Smecta

Way to try to help animals at home.As an old dog.These symptoms can be severe onset of disease.I recommend a visit to your vet.

Good luck

Aurelijus

Re: Canine pancreatitis treatment

Andrew Kent — Sat, 11 Sep 2010 17:37:25 GMT

If he is vomiting and off food then I would really be hospitalising him for IVFT and opioid based pain relief. I would also be doing some abdominal imaging to ensure this is not a foreign body. My concern with the PLI testing for pancreatitis is that it will often elevate significantly as a secondary consequence of other gastrointestinal disease (foreign body, peritonitis etc) so should be used with other diagnostics.

Other treatment is largely symptomatic - anti-emetics, sometimes appetite stimulants, sometimes fresh frozen plasma if sick enough/falling albumin.

It sounds to me like he would benefit from being admitted. If she wants to try him at home then could consider adding tramadol.

Andy