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Thora won't eat.... pancreatitis or ?? (liver/kidney bloodwork update)

Discussion in 'Dog Health issues and questions' started by Tuff Love, Jul 27, 2015.

  1. Tuff Love

    Tuff Love Boxer Insane

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    I am at the end of my rope. 4 years later and Thora is still having issues that my vets can't get to the bottom of. I am so tired of watching my girl suffer... it just breaks my heart. Why is it so hard to get a diagnosis and get her better?!?!

    Anyways.... Thora isn't eating. Saturday and Sunday she picked at her food, but for the most part she would sniff and walk away She eventually would eat by the end of the evening, but wasn't enthusiastic about it and it took her several attempts to finish it all. She laid around all day and was clearly just not feeling well. This morning (Monday) was a repeat. She didn't eat before I left for work and laid around all morning. We have a towel under her bowl because she makes a mess of the Sojos/Wellness blend, and she was nosing the edge of the towel like she wanted to cover her food? But then she just walked away. I thought we had figured out the triggers to her problem (see this thread https://boxerworld.com/forums/threads/we-figured-it-out-anxiety-triggered-stomach-chaos.171055/), but this came out of the blue. Usually when she has an attack like this it lasts half a day and she recovers. It is usually accompanied by diarrhea and often some vomiting. Not this time (yet). Her poos are on the soft side, but she's mostly been eating kibble since I can't leave the Sojos out and her poos are always soft when she doesn't have the raw mixed in. Yesterday her belly was squealing a bit like it usually does when she has her attacks, but other than loss of appetite and depressed, nothing else is jumping out. I gave her some pepcid 3 days in a row now because the vet said it might help. She saw the vet 7/13 for her annual shots and they ran blood work on her liver & kidneys in order to prescribe us Xanax for her anxiety, and the results are mildly elevated for both. The new vet remarked that her liver enzymes were slightly elevated last time she had blood work done but the kidney is new. (Last time was maybe 6 months ago - we had her in for a particularly bad episode when I switched her food- they found nothing and put her on flagyl and an rx probiotic.) He wants me to bring in a urine sample to investigate further but I haven't had time to get a sample over, so I'm going to try to do that tomorrow morning and have DH run it over in the afternoon (does urine go bad?).

    These are the results of her most recent bloods. I googled, of course, but it didn't tell me a whole lot. The vet said *it's possible* that her frequent episodes of sickness could be the cause of the elevations, but he can't say for certain.

    ALT 44 (5-50UL)
    ALPNEW 547 (6-64UL) ***
    TBILI 0.3 (0.1-0.6MG/DL)
    TP 7.2 (5.5-7.1G/DL) *
    PHOS 3.5 (2.5-5MG/DL)
    GLU 119 (70-118MG/DL) *
    BUN 21 (8-24MG/DL)
    CREAT 1.3 (0.4-1.2MG/DL) *
    GGT 6 (0-20U/L)
    AST 22 (10-62U/L)
    CK_NEW 311 (50-300U/L) **
    BUN_CR 16.2 (4-27)

    Not one of the vets has mentioned pancreatitis when we've brought her in and discussed her attacks. I don't know a whole lot about it but I know a handful of regular members have dealt with it. Does this sound like it? She's VERY sensitive to food changes, so she gets very little handouts and is on high quality food. I tried digestive enzymes a few times but nothing ever seemed to change and they were expensive, so we stopped. Someone... err, Pam maybe? suggested psyllium husk, but the few times I've remembered to look for it I couldn't find it. I just ordered Milk Thistle caps to try for liver therapy.
     
  2. Tuff Love

    Tuff Love Boxer Insane

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    BTW, the main reason I question pancreatitis is because one of the causes of high ALP levels is pancreatitis (in addition to her symptoms). She has had GI issues since puppyhood.

    Dr. Google says this about High ALP:

    Causes of increased total ALP activity can be classified as: 1). Age (young dogs) and breed-related considerations (Siberian Huskies with familial hyperphosphatasemia; Scottish Terriers); 2) Drug-induced (corticosteroids, phenobarbital, others); 3) Cushing's Disease; 4) Primary hepatobiliary disease (intra- and extrahepatic cholestatic disorders, including vacuolar hepatopathy, cholangitis, hepatitis, neoplasia, nodular hyperplasia); 5) Systemic disorders causing reactive hepatopathy or physiologic stress associated with acute or chronic illness (neoplasia, infection/inflammation; pancreatitis; GI disease; endocrine disorders such as diabetes mellitus, hypothyroidism) and 6) Bone-related disorders (neoplasia, nutritional osteopathy, hyperparathyroidism)

    For the record, Thora's thyroid has never been checked but she has always been a petite yet stacked girl. Very lean but also pretty muscular for a little girl. Weight usually hovers just between 46-49 pounds, depending on how well she's eating and how frequent her episodes are.

    Her attacks are *typically* associated with extended exposure to the stimuli that triggers her reactive behavior (aka, house guests). So she does fit the criteria for #5, if I am understanding it properly.
     
  3. silly24boxer

    silly24boxer Super Boxer

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    I have come across the same thing with my soul boxer boy Gauge. We where at a complete loss for 6 yrs of his life. It started at about 7 month old, we would feed him 15 mins later he would shiver and shake he was in pain. After that he refused to eat, we really had to encourage him to eat. If he would not eat he would get sicker. Once we had it under control he would go a few days with out this happening. After a few vet visits, we tried a lot of stuff, like feed him while walking, feed him more often, snacks before bed etc. This still continued finally early one morning I could tell he was going to have a reaction again I quickly called the vet met her at the office. We tubed his stomach, did X-rays and ended up getting his stomach tacked. Thought that would solve the issue but no it continued, we did find that feeding him more often helped. We tried home cooked, raw, and all different types of dry, and canned. Not to mention all the vet bills, all the testing, all the drugs. We decided all we could do was manage him as best we could. Than one day Gauge was limping, to make a long story short we ended up about to have an ACL surgery but has blood work showed stage 2 renal failure. Gauge had so many health issues and now this. We were already see a top specialist for his ACL so now we were referred to an internalist. She did a lot of testing and ultra sounds and once again switched his food. Of course to a kidney diet, will my poor boxer was so sick, we ended up at the vet they did a pancreatitis test and guess what. That is what he had. My vet and the internalist put all his records together from all the different vets we have seen and figured out Gauge had had pancreatitis all his life. No other vet we had seen had tried a simple snap test to figure it out. So having pancreatitis for 6 years of his life took a toll on his kidneys. In the end there was no real food we could feed him any more that would help him but a veggie diet. My soul boy passed away just before his 7 birthday. I know what you are going through and is very hard. I would get Thora blood tested for pancreatitis, even if it a bit elevated I would feed her and treat her for it. There is more to Gauges story but it would be a book.
     
  4. Tuff Love

    Tuff Love Boxer Insane

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    Oh my gosh... poor Guage :( I came across a good number of your posts when I searched BW for posts on pancreatitis, so thank you for writing in. I dropped off Thora's urine sample this morning and it was checked for concentration. Her (new) vet called me not even an hour later to let me know concentration was great and kidneys are working fine. I picked his brain about what he thought and why on earth her alkaline phosphate levels are so high, and he said basically what I already had found- that the ALP levels come from many different sources so the test doesn't point to any one problem and that the 3 core liver markers were all normal, which is good. He said if she was drinking a lot, peeing a lot, with a large belly, and in general poor condition at all times, he might consider Cushings, but because she doesn't show any of that, he thinks it highly unlikely. Also because she does for the most part have a trigger, and then bounces back, he thinks it unlikely. He reiterated that the ALP levels could very well be high because of her repeat episodes of digestive distress and said he could offer us a referral to an internist if we want and they could biopsy or he could run any number of tests, but it could very well lead us right back to square one. I said do you think pancreatitis? He said, is it possible? Could be, but you are doing everything right with diet, etc etc.... He said he does have a number of dogs who have stress triggered colitis issues and suggested keeping Flagyl on hand. I asked if the repeat use of this drug was safe and he said absolutely yes and that he uses this treatment on a number of dogs.

    SO. Now what? :( The vet's advice at this time was to keep the Flagyl and Xanax on hand and use it as necessary to treat Thora's episodes and keep what we're doing with her diet and training. Recheck bloods in about 3 months to keep an eye on things. I asked his advice on Milk Thistle and he didn't have much to offer because the important liver markers were good, which wouldn't suggest liver disease.

    I don't know where I should go from here. We do have insurance, but I could spend thousands exhausting every test out there... money is tight with our son in the picture now. I would absolutely do more extensive testing if I knew it would get us answers, but we don't even know where to start on tests because any number of things could be going on. Moving forward, do I just assume she could have pancreatitis and attempt to alter her diet? Last time I tried changing foods she had colitis for a MONTH. Changing foods is not something we do lightly with her. And where would I start? We have been highly suspicious of a chicken allergy her whole life, so all chicken formulas would be out, or I could risk her getting ill again. Many of the low fat diets have chicken as the protein. Right now she is on a combination (1/2 & 1/2 each meal) of Wellness Core Ocean (16% min fat, 34% min protein) and Sojos Complete Turkey (12% min crude fat, 16% crude protein) . She did GREAT on this combination for a solid 2 1/2 years until I tried switching her food to something slightly cheaper (NB LID Sweet Potato &Fish).... all hell broke loose and now her system seems much touchier than it used to be and I'm not sure she tolerates the Ocean Core as well anymore. She does GREAT on Sojos alone, but 1) it's very expensive and 2) she loses too much weight on it (skin and bones after 2 weeks). I feel like her body doesn't extract enough nutrition from her food because she is ALWAYS hungry and never gains weight and is constantly pooping! She still poops 4 times a day, sometimes 5!

    Last night when I got home from work she hadn't touched her bowl of kibble and DH said she had an accident in the house (typical when her belly is sick). I threw out the mix of Sojos/Wellness from the morning that I had in the fridge and she watched me and nosed her food bins, like she was hungry (despite not touching her food). I thought it best to just let her system relax and keep an eye that she's drinking ok. After an hour or so she brightened up and was barking at me and dancing around her food bins, clearly hungry. So I gave in and offered her a small amount of Sojos only. She devoured it and was looking for more. An hour later I gave her a little more and before bed a little more. She gobbled it all up quickly. Today so far she seems like she's feeling good, so right now I'm going to keep her on Sojos until I figure out what else to do. I know within a week though she's going to be so skinny from not getting enough fat/calories from the Sojos. She didn't drink much water last night but the Sojos has a lot of water in it from rehydrating it so I'm not all that concerned just yet.

    Sorry that was long... I am just at a loss here...
     
    Last edited: Jul 28, 2015
  5. silly24boxer

    silly24boxer Super Boxer

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    You seemed to have exhausted all other measures and need to just manage the issues. We did the same it's all you can do for now. Use the food that works for her, do not give anything else, not a table scrap or anything. We give Pepcid ac twice a day with meals also sulcrate when needed. We figured out we had too feed Gauge every 8 hour so three times a day with a snack before bed. This kept him in check unless he got into some other than his food. Look up pancreatitis, we didn't find out early enough to be able to make a difference. Pancreatitis is very painful and there are new findings suggesting that pancreatitis starts to effect other organs near by in Gauges case his kidneys. All this is so hard to figure out as you could tell by reading my all my post, you will go crazy trying to figure it out. So your new thinking should be manage and maintain. We gladly had vet insurance also. I added the claims up 18,000.00 in 6 years. There is a lot of good information on the whole dog journal of what you can try feed her. You can also email Dr Jean Dodds she has given me some support also.
     
    Last edited: Jul 28, 2015
  6. Tuff Love

    Tuff Love Boxer Insane

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    Management is what we've been doing, or trying to do the best we can. It worked for a while but now she seems more sensitive than ever. I just can't stand to see my girl in pain like this all the time.
     
  7. Gatorblu

    Gatorblu Boxer Insane

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    If you remember Thor had pancreatitis and the big thing there is to keep the fat down. Any extra fat in his diet sent him into a flare up. His initial attack lasted months and was misdiagnosed by the vet until I asked them to check for it. Because of that it became a chronic condition. I checked fat content on EVERYTHING that went into his body. My husband, not so much until after the second $700 vet bill from him giving scraps. As much as I don't like Hill's Prescription in the end it was all I could use for him. Hopefully you have caught Thora's in time and don't need to go that route.

    After Arabella had a bout with pancreatitis awhile back I switched her to Petcurean's NOW Senior, even though she wasn't a senior at the time. She did really well on it. I switched her to Wellness Reduced Fat formula recently because it is easier to get where I live. Because she has always been very active I have given her a bit more than what the chart on the bag recommended and she has kept a good healthy weight. Arabella HAS to stay grain free so I am hoping by staying on top of her food and treats we never have a repeat of pancreatitis and it never becomes a chronic issue.

    I wish you luck. It can be a very trying and scary issue at times. When Thor's flares were bad he wasn't even allowed water for the first 24 hours, and sometimes 36 hours, and I had to take him to the vet for an IV. We had become so routine with it they would have him on IV during the day and give him fluids subcutaneously right before they closed the office and I would bring him home for the night and take him back when the office opened in the morning to evaluated if he could drink again. Then a bland diet for 4-7 days, and then slowly add the Hill's back in over another 7-10 days. Keep us posted on how Thora is doing.
     
  8. Tuff Love

    Tuff Love Boxer Insane

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    I do remember Thor's issues with pancreatitis and I too have been hoping to stay away from those crappy vet formulas, but at this point I will gladly feed her whatever keeps her healthy and pain-free. The fat content in the Wellness Ocean that Thora gets is a little high compared to some other foods (16% from what I see online) so that might be problematic. We always mix it with Sojos so her meals aren't truly 16%. The only reason I even give her dry kibble at all is to help her keep on weight, otherwise she is scrawny and sickly looking (Sojos is low calorie and lower fat). I'll keep Petcurean in mind. I did come across the Wellness RF formula while searching low fat foods and we might try to swap out the Wellness Ocean in her diet for that first, but I think it has chicken in it, which may be problematic if she has a true chicken allergy. I'm just so scared to make any food changes from our last experience. I know we have to do it very gradually and we always have. The vet has Flagyl waiting for me to pick up so I'm going to keep it handy when we start a food change and administer it at the first sign of trouble.

    Forgive my memory, did Thor relapse while on the Hills? Or was there something else that caused him to relapse once you had him on the Hills? We have the additional issue with her reactivity, which seems to be her biggest trigger. I don't know if that irritates pancreatitis (if that's what she has). For a while I just assumed she has an ulcer as I know stress in people can irritate ulcers and of course there's HUC in boxers.
    In most cases she bounces back completely within about 12 hours without any IV or anything. She doesn't eat the entire time on her own accord. Not saying she probably wouldn't benefit from IV fluids because I"m sure she gets very dehydrated from the diarrhea.
     
  9. Gatorblu

    Gatorblu Boxer Insane

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    Sorry, I took so long getting back. I have been helping my mother-in-law move. The only relapses I remember after doing strictly Hill's, was when DH would give him a treat he shouldn't have, like ham. dohicon Thor was also fed three times a day so as not to overwork his system with any one meal. That made a big difference in managing his condition as well.
     
  10. silly24boxer

    silly24boxer Super Boxer

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    Yes I agree, to manage this feed more often, stick to the food that works and nothing else. ( a piece of watermelon set Gauge off once). As much as we didn't agree with using vet food, I learnt you have to do what works.
     

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