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Pancreatitis and HGE.

Species: Dog
Breed: basset hound
Age: 5-8 years
I had my Cooper put to sleep 3 weeks ago today. On the Monday before, he vomited once in the morning, but seemed ok, other than not being excited about food. He did eat though, and was walking around. We assumed he had eaten poop (which he did often) and had an upset tummy. By that evening, he was vomiting much more and we came home to bloody diarrhea in the kitchen. We took him to the vet, who suspected HGE and pancreatitis. His bloodwork showed evidence of both. We had the option of leaving him there to get fluids and other meds, or taking himi to an overnight ER, where they might do an ultrasound (this cost was going to be $500 to $600). We all assumed, including the doctor, that he would probably improve by morning but would have to stay hospitalized there for at least 3 days. so, rather than take him to the ER, we chose to leave him there at the vet overnight, where he was administered fluids, potassium, metronidazole, ampicillin, famotidine, and cerenia. The next morning he was worse, and the doctor said there was much more blood over night than he expected. They thought he might have a tear in his colon. They had already done xrays the night before that looked good. But, he did a different xray the next morning with some kind of gas that would show if there was a tear or blockage in his colon. There wasn't. He had also told me that his rectum was so inflamed that he couldn't even examine it with his fingers. Later on in the morning, he called and said he thought we were going to lose him. He temp was dropping, even with heated fluids, heating pad, and blankets, and his intestines were shutting down, gas building in his stomach. I went over there. My only options were to put him to sleep, or take him to the local university who the doctor had already been in consulation with, and had tried two things they had suggested (the gas xray and placing a stomach tube in to try and relieve the gas). He was too weak to withstand any kind of surgery and basically looked almost dead already. They had given him pain medicine, then later reversed it to see if he would show any signs of movement. He barely raised his head once when i came in, but that was all. he was lethargic and very cold. I decided to let him go. I am so unsure about whether i made the the right decision, and haunted by leaving him at the vet alone overnight where he might have been in pain and scared, and maybe this exacerbated his condition? So, my questions are, do you think these were appropriate treatments? Would you have done the same? The doctor told me that cerenia helps with visceral gi pain and that likely helped him feel more comfortable that night, but they didn't give him anything specifically for pain,and i keep reading how painful pancreatitis is. The doc just didn't think he was in much pain cause he palpitated his stomach to check for pain reaction and there wasn't any. The doc also suspected that maybe he had some underlying cancer of disease that these other things were secondary to, because he declined so fast and had so much bleeding. I'd just like your opinion on everything, and mainly if you think the cerenia helped his pain that night. Thanks, dAphne

Online vet, Dr. Marie

Dr. Marie replied:

Oh, cases like this are so difficult for everyone involved. I'm so sorry to hear of Cooper's illness.

It does sound like your vet did all of the same things that I would do. I wish I had some answers for you as to what was going on but we will never know what the actual culprit was. All that we can say is that it was definitely something very serious. While most dogs with pancreatitis or HGE do recover with the treatment that Cooper received, either condition does have the potential to be fatal. Given that he had both conditions this would have made things even more difficult for his poor little body.

The medicines are all the same that I would use to treat a dog with severe gastrointestinal symptoms. The famotidine and the cerenia would definitely help with abdominal cramping.

When it comes to pain relief, we sometimes have difficulty deciding what to do when there is pancreatitis, and especially when there is evidence of bleeding. Many of the pain relievers that we give could make bleeding worse.

When I have a dog with gastrointestinal symptoms I will often start with cerenia and then decide whether or not to add other pain medications based on how the dog is doing. The vet should have been able to get some indication of how he was doing by feeling the abdomen just behind the ribs. When dogs have pancreatitis, they will usually be super painful when you feel this area. I have had a number of dogs that were very painful, but then within an hour of a cerenia injection they allowed me to palpate that area without showing pain. But, if I find that they are still painful I will add some narcotics. One of the problems is that most of the narcotic drugs that are used for this kind of pain only last for 1-3 hours. Sometimes I will use something called a fentanyl patch which works for several days, but the problem with this is that it takes 12 hours sometimes for the medication to kick in.

It sounds like your vet did all of the right things. While I can't say for certain whether there was pain, I can't imagine that the vet would do everything that they did and ignore analgesia (pain relief). It sounds to me like the vet felt he was well covered with the drugs that he did have.

From what you have described you made the right decision when it came to euthanasia. It doesn't sound like there was anything that could have been done to save him even if he did go to the university.

I'm so sorry for your loss. Please know that you did nothing wrong. Sad things like this unfortunately happen. Let me know if you have more questions.

Dr. Marie.

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Customer reply:

Thank you for that reply. I have really been tortured thinking of him spending that night alone at the vet, maybe in pain and scared, and thinking mabye that was so stressful that it made him worse. I've also wondered if his low temp and intestinal paralysis on the next day were maybe reversible or temporary, but they had been trying raise him temp with heated fluids, blankets, and a heating pad, to no avail. I hope I did the right thing, I'm just sorry now that I didn't take him to an ER to spend the night so he could have been monitored and maybe made more comfortable if he seemed to be in pain later in the night, and they could have done an ultrasound, although I keep reading that those can be inconclusive too, just like xrays. There are many what ifs here and I am just heartsick that I didn't immediately take him to the vet that morning when he seemed to have a tummy ache. I never dreamed he would be dead the next day. He was really bonded to me and vice versa so I am really questioning myself and missing him terribly. It's comforting that the cerenia and other medicines hopefully made him feel better at least. The vet did press on his abdomen but I'm just not sure if Cooper would have shown if he was in pain or not. Now I'll never really know, but I will have to hope that his last night wasn't spent in terrible pain and stress. I had hoped he would live to be 14 or 15 and be put to rest in our home. Anyway, thanks again. I appreciate all the information. Daphne

Online vet, Dr. Marie

Dr. Marie replied:

Daphne, I don't think the outcome would have been any different had you gone to emerg. You likely would have had more tests done (and spent more money), but if your poor Cooper died that quickly my guess is that it's unlikely that anything could have been done to save him.

Customer reply:

Do you think the low temp and intestinal paralysis meant that his body was shutting down? maybe multi-organ failure? i've been so worried thinking maybe he was just in shock and could have come out of it, that maybe i should have waited a few more hours. our great dane got very sick with addison's a few years ago, we didn't know he had it and he went into an addisonian crisis while we were boarding him and on vacation. he came out of that with expensive treament and several days at the vet, but then in just a few days went into heart failure. we tried treating the heart failure at home for a week or so with meds, but he was not having a good quality of life. we have since said many times that we were wrong to force him to live those extra few days, forcing somany pills down him daily, and him suffering. i didn't want to do that to cooper, so i just based my decision on that. i will try to stop asking anything else after this. i appreciate your patience.

Online vet, Dr. Marie

Dr. Marie replied:

No need to apologize. I don't mind your questions at all. The decrease in temperature and intestines shutting down were very likely part of the process of dying. When I see a sick animal with a low temperature this is a sign that they are possibly about to die.

If he was in shock he would be dramatically better after receiving the IV fluids and other medications that he was on. I can't see any way that he would have recovered from this horrible thing.

Customer reply:

Thank you. The vet said his temp had started dropping that morning, but had been hovering around 100 before then.

Just so hard to think about him suffering like that and dying so unexpectedly. He was so young and full of life and mischief. He did vomit occasionally, but as I said, he liked to eat poop so we assumed that's why. Now I wonder if he had mild chronic pancreatitis.

The vet also sent in a cytology of cells from his colon, and the skin cells seemed normal, but the vet said that he still could have had some kind of cancer, maybe intestinal. But, they did see he clostridium bacteria there.

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