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Dr L Simmon
Dr L Simmon, Dog Veterinarian
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Experience:  Veterinarian MVB MRCVS
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My dog has pancreatitis. She has been on iv fluids in vets

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My dog has pancreatitis. She has been on iv fluids in vets for three days. Lipase raised in blood. X-ray and ultrasound scan. Nothing abnormal seen. Now on an ace inhibitor once a day. Zantac, lomac and anti sickness meds. Doesn’t want to eat royal canin gastro food and is still bringing up bile coloured liquid. can you suggest another food please?
Assistant: What medications do you take daily? Are you allergic to any medications?
Customer: I don’t know if she is allergic to any medicines. Antibiotics are xeden and noroclav. Metoclopramide for sickness, Losec and liquid Zantac. Fortekor as ace inhibitor am.
Assistant: Anything else in your medical history you think the Doctor should know?
Customer: No. She is a westie and has a few skin problems on her feet
Hi there, you are through to Dr Linda. Just a few minutes as I type my response
Customer: replied 1 month ago.
Also is it good to give 3 different types of sickness meds or should I concentrate on one?
I'm so sorry to hear your little Westie is unwell.
It sounds as if she is being well taken care of and is getting great care.
Can I confirm as well as the medicine she is on she is getting some pain relief? We know that pancreatitis can be very painful and many dogs do not want to eat because of this. An opioid pain relief such as buperenorphine which can be given I.V. several times a day is strongly advised.
Similarly, has she been given any appetite stimulants? These may well be worth trying, if only for a day or two to convince her to start eating again.
If this does not help, we will have to consider alternate feeding options. Some dogs will accept syringe feeding from nurses while others may require the placement of a temporary feeding tube. Certainly, we know that nutrition plays an important role in the recovery from pancreatitis and the most recent research advocates feeding throughout the condition.
Food wise, the key is to provide a low fat food. Other diet options include Hills I/D Low Fat or Purina Proplan EN gastro (although this one has slightly more fat than either Hills or RC).
Warming the food and hand feeding may help with appetite.
Offering a small amount of skinless boiled white chicken to whet the appetite would not be inappropriate, just to get the ball rolling.
Most dogs start to turn the corner after a few days so fingers crossed she starts to feel better very soon.
Customer: replied 1 month ago.
What happened?
What 3 anti sickness medicines is she receiving?
The metoclopramide you mention can help reduce nausea and is a good prokinetic so can help with GI motility if it has slowed (this may have been seen during ultrasound). However, a side effect that can be seen is lethargy and sluggishness, so it may be worth seeing if stopping it helps with her eating.
Maropitant (cerenia) tends to be the best anti-nausea med as it targets nausea/vomiting regardless of the cause. This would be my first choice in pancreatitis cases.
Losec is not an anti sickness medicine, it is an ant-acid (proton pump inhibitor).
Similarly, zantac is a H2 blocker and also helps reduce acidity. Both Losec and Zantac are commonly used together.
Apologies if the computer has suggested a phone call, it does this automatically. I am unable to make phone calls but am happy to continue to talk via chat.
If you would specifically want a phone call I can opt out of this question and there may be another vet available who can speak to you
Customer: replied 1 month ago.
Do you know a vet in Northern Ireland who specialises in pancreatitis who I can visit with my dog? Bonnie doesn’t seem to be in pain now although I know that she was earlier. Her biggest problem at the moment seems to be vomiting. I have just given her some boiled white rice with little bits of pure turkey. She seems keen enough to eat but doesn’t seem to be able to keep it down. Where would I get maropitant? If I stop the the metoclopramide should I continue with Zantac and Losec?
Is she not in a clinic at the moment? I thought she was on intravenous fluids? If not , it would really be the best place for her as it sounds as though she is still suffering from an acute bout of pancreatitis. It should really be the vet in charge of her case that is deciding on the medicine she needs, as her owner that decision is simply not one that should be put on your shoulders. Treatment plans often change from day to day depending on how the dog is responding so medicines should not be altered without examining the dog.
As we know those with pancreatitis are in pain (whether they show obvious signs or not), pain relief should always be a staple part of the therapy plan. Even mild pain will decrease appetite.
If maropitant/cerenia has not been tried this may help with nausea/vomiting and will have to be prescribed by the vet.
Turkey and rice is bland, low fat and highly digestible so I would continue feeding this little and often if she is accepting it.
Unfortunately I cannot personally recommend any vets (and I work in West London so am not familiar with Northern Irish vets) but your vet would certainly know all of the local hospitals/specialists and should easily be able to refer you and forward on her medical records.
Customer: replied 1 month ago.
I have just been to vet for Bonnie to get a cerenia injection. Bonnie came home and ate more! She said this injection only lasts for 24 hrs but they don’t have the tablet form? She is definitely more alert today and temp is now 38.4 C which is good as it was 39.9 when she was discharged. I am going to continue on turkey and rice for a few days - maybe change to brown rice?
Thank you so much for your help!

That's a big relief and I am really glad to hear it, I certainly find I get great results with Cerenia as not only is it a potent anti-nausea/anti-vomiting injection, it also thought to provide some local pain relief inside the abdomen (visceral pain relief).

Though your vet does not have the tablets, they could issue you with a prescription to get them online or from another vet that does. Alternatively, if you find she needs a top up tomorrow, you could always have her back in for another injection. The nice thing with the injection is that even if they have a vomit, they still get the full dose of the medicine!

Whichever rice she prefers is fine. We tend to say white rice as this was what was easily available in past years, but brown rice is more nutritional. However, it contains marginally more fat so white could be safest at least for the next few days.

Dr L Simmon and other Dog Specialists are ready to help you

Thank you very much for the kind accept. Please do feel free to keep me updated on how she is getting on and to ask any more questions you have over the next few days.

Customer: replied 1 month ago.
No further vomiting, thank goodness. Thought I might wait to see how she is tonight before getting more meds - what do you think? She isn’t restless and when for very short walk this morning with normal pee and poo. Bonnie has eaten 3 small amounts of turkey and rice today already.
That all sounds extremely encouraging- well done Bonnie! I would agree with taking a wait and see approach and if all continues in this direction she should be just fine without getting more medicine:)
Customer: replied 1 month ago.
No need for phone call now.
If you contact customer services they should be able to cancel the request and refund any money paid. I will flag this to them also
Customer: replied 1 month ago.
Good afternoon Dr Simmon,
Bonnie hasn’t had any further vomiting and continues to eat small amounts of her turkey and rice throughout the day. She has been for a couple of short ( slow) walks today.
I haven’t given her any more meds ( zantac etc) as I didn’t want to upset her stomach and she seems to be managing- am I doing the right thing?
Thank you for the update and I'm really glad to hear things are progressing nicely.
I agree if all is well, we would want to continue with the bland diet and reduced exercise.
Zantac can be useful to continue depending on how long she has already been on it for. Side effects would be rare and it can help prevent stomach upset. I would give it for the duration of the course prescribed by the vet (typically anything from 3 days to 2 weeks).
Customer: replied 1 month ago.
Bonnie has been on the liquid form of Zantac for a week. I have a little bottle and don’t know how long that will last. She doesn’t like it and spits it out. I also have 75 mg tabs which I bought before going to vet and could try 1/4 of this in food?Am nervous incase vomiting starts again although the Losec brought on severe vomiting. I am sorry to bother you again but find your answers really helpful.
You're not bothering me at all- very happy to answer any questions!
As she has been tolerating the liquid zantac the tablet version should also be well tolerated. Her dose would be 2mg/kg. The average westie weighs about 8kg so would need 16mg which is more like a fifth of a tablet. To be honest, as she has had it for a week and seems settled, I would probably suggest stopping it (unless her vet has specifically advised a longer course).
Customer: replied 1 month ago.
Thank you. Bonnie was 9 kg and has dropped to 7 kg during illness and not eating. I think if I continued I should maybe use the liquid one last thing at night or early in am? She is now sitting and begging for our food but we don’t respond. I was thinking about the purina food when Bonnie is ready to build her up but don’t want to attempt it too soon? Also not sure to try wet or dry food?
I have discovered that the park where I would normally walk her has been spraying and another lady told me that a lot of dogs were sick! I was wondering if this has caused Bonnie’s problems........
Customer: replied 1 month ago.
Also wondering about probiotic for her gut?
I agree as she is quite small, the liquid would be best if continuing. It's usually given twice a day at intervals of 12 hours so most dogs have it first thing in the morning and last thing at night.
The begging is good as she must have her appetite back! We definitely do not want to offer any treats/human food/ chews as this could risk a flare up.
She should be fine to transition on to a low fat diet from now. This should be done gradually over 5 days I.e. tomorrow you could give 1/5 of the new food with 4/5 what she is eating at the moment, mixed in well. The next day she would have 2/5 of the new food with 3/5 her old diet etc. If at any stage it upsets her stomach, take a step back and make the transition slower.
Wet or dry can depend on the dogs preference. If she eats either I would go for the one with the lowest fat content. Keep in mind that dry diets are best for dental health and wet diets can be useful for those with urinary issues.
Do we know what was sprayed in the park? As so many people walk dogs in the park the council are normally good at using pet safe products. You can always contact them to enquire but I think it is unlikely that this is linked.
A probiotic has its place and is especially good to give to those who are on (or have just been on) antibiotics as it helps the gut populate with 'good' bacteria. Beware of any products that are flavoured or have additives as some may contain additional fats which would not be recommended for her. Similarly, some contain anti-diarrhoea ingredients such as Kaolin and Pectin which we would want to avoid in case they bunged her up.
Customer: replied 1 month ago.
Good morning Dr Simmon,
Bonnie continues to make good progress with no further vomiting. However,as I told you yesterday she has lost a lot of weight and although she is eating turkey and rice I feel that she needs a more balanced diet in order to build up her strength and body.
Last night I contacted pet stores to see if I could get purina but couldn’t find it. Most vets stock Royal canin but Bonnie was very sick with this and would like to try another. Thought I should start on wet food and then add in dry kibble. I looked at James wellbeloved turkey and rice because a lot of westies have this because of their skin problems? Bonnie has a good coat but licks her paws a lot.
I know that we are nearly there and you have been a wonderful help to me. I appreciate it more than you will ever know!
This is certainly not a bad food option and may well be one that is well suited to her.
However, if we could get her to accept it, Royal Canin Gastrointestinal Low Fat is ideal for those who have had pancreatitis in the past. The dry version only has 7% fat while the wet version has 1.7%. This is a very low fat content and so is ideal to prevent pancreatitis.
James Wellbeloved has a moderately higher fat content (10.5% in the dry food and 4% in the wet food) but it is still a reasonably low amount.
I agree now is the time to wean her onto a complete diet so she is getting all of her nutrients. Either of the diets I mention above would be appropriate. Be sure to make the switch gradually over a few days & good luck!
As another comparison , Hills digestive care low fat contains 2.2% fat in their wet option and 7.7% in their dry option. Again, this makes it an ideal choice for pancreatitis prevention.
With any if the aforementioned foods you could feed just wet, just dry or a mix- whatever she prefers!
Customer: replied 1 month ago.
Thank you. I got a tin of Lily’s kitchen recovery diet last night. It says with chicken, potatoes and bananas - perfect for poorly dogs with sensitive stomachs. However 9% fats and oils. A little worried about Royal canin because pork and don’t think that Bonnie tolerates that- vomited the whole lot back and then continues to vomit all night.....
Ah I see, that is fair enough! It really is a balancing act between what suits her, what she likes and what has a relatively low fat content. Realistically, we dont have to give the lowest fat food on the market as long as she is fed one low fat food that is the main thing.
Customer: replied 1 month ago.
Also found another good in pet store called Axa - low fat. Have you heard of it?
I have heard of Ava though not Axa. Ava does have a good reputation and I have many clients who use it & are generally very pleased with it.
Customer: replied 1 month ago.
Unfortunately Bonnie isn’t so well today. She didn’t want to eat and I took her back to the vet and he checked her kidney function. The urea and creatinine levels were elevated.He gave her another cerena injection incase there was some nausea and he told me to put her back on the ace inhibitor(Fortekor) and find a low protein diet for her kidney. I found the Ava one but she isn’t interested in eating and trembles from time to time. Would the injection or the ace inhibitor cause her to be restless ? She is wondering round in a daze and not nearly as alert as before.

Oh bless her, she is having a hard time of it isn't she?

Fortekor (benazepril) can potentially lower blood pressure so I would consider a blood pressure check to ensure this is not the case. Additional potential side effects can include nausea, decrease appetite and diarrhoea. It is good that she has had the Cerenia as hopefully this will settle her stomach over the next 24 hours.

If she has not been eating/drinking well, she may feel a little weak and out of sorts. We certainly want to encourage eating & drinking as best we can. There are many renal diets on the market in a variety of flavours and textures- most of the big brands will have one or two that they offer & you could see which she prefers.

For some dogs, a trip to the vets, an examination and the feeling of an injection can also be a bit stressful so this likely hasn't helped any restlessness. We would hope that she would settle soon.

Customer: replied 1 month ago.
How can you check a dog’s blood pressure? At the vets? She is drinking( but not too much) and not eating at the moment.

Yes this has to be done at the vets (in a similar way to how it is done for us, with a cuff).

Customer: replied 1 month ago.
When the vet examined her he said her abdomen was soft and he thought the pancreatitis had passed but she has been eating too much turkey - protein.

It's good that her abdomen is soft, hopefully indicating she is not in any abdominal pain. However, the only way to knoe for sure would be to run blood tests and/or ultrasound the pancreas. Some dogs have a grumbling, low-grade pancreatitis.

Certainly a protein rich diet can contribute towards higher levels of urea (one kidney biomarker) in those with reduced kidney function. If turkey is the only thing she is eating though, this is preferable to nothing

Customer: replied 1 month ago.
Bonnie is in the vets again to day. She deteriorated during the night and I took her to the surgery at 9am. The vet put her on iv fluids as she said she was dehydrated - very flat. Shortly after arriving she started to pass bloody diarrhoea. No change tonight- still on iv fluids and passing bloody diarrhoea..........
Customer: replied 1 month ago.
Temp 39 .4C
Oh poor mite. It sounds as if the vets is the best place for her as she is now dehydrated. If not already done, repeating blood tests (include the pancreatitis test) and abdominal imaging may help us understand why this has happened. Similarly, analysing a faecal sample could check for any infections.
Customer: replied 1 month ago.
Bonnie diet during the night
Customer: replied 1 month ago.
Sorry. I should have said that I got a phone call to say that Bonnie died during the night
Oh I am so, so sorry to hear this. I hope you and your family are doing okay. What a shock as I know she had seemed to be on the mend.
I know it is easier to say than to do but try to remember the good times you had with her. It is very clear to me that she was a big part of your life and that you were a wonderful owner to her; she was a lucky girl.