It’s been a long time- Pep having trouble with swollen elbow

[BrookeR]

It's been too long since I have last been on here. I always mean to check in every now and then but life gets busy. Sadly my pep (impa sufferer) is having trouble walking. She has a very swollen elbow and limping badly.
I was out one day 3 weeks ago now and she was fine when I left and when I came home she was limping. On the odd occasion that no one is home (myself and my partner both work from home) she sometimes would get up on the lounge. Then when she jumps off she hurts herself. I had believed that this is what happened this day I was out. As it appeared that she was limping on her front leg. She is a staffy and has really bad muscle wastage especially in her chest/shoulders due to the long term pred uses.
We have had a lot going on the last few weeks including my 6 year old having surgery so unfortunately I have had to try keep pep comfortable until I could focus on her. She improved some for a week or more but has been struggling again more the last few days. I noticed her elbow was swollen a few days or so in and then it appeared to not be as bad for a while but now it's looks more swollen again.

Pep is now 12 years old and is prone to pancreatitis as well. She also has bad arthritis mainly in her back legs. Which is causing her to have trouble getting up since she is having to rely on her back legs more while she protects her front elbow. Our whole house is tiles which makes things a lot harder for her. Especially when she hurts herself. I don't mop the floor anymore as this makes it impossible for her to walk. I have put a non slip runner coming from her bed down the hallway. I have considered getting toe grips for her to see how they go. Being a staffy she loves laying her belly our starfish on the cold tiles. It's impossible to stop her so I have to try always be around to help her get up so she doesn't slip out and hurt herself more. However, it doesn't matter how many things I put in place to help her she always seems to go out of her way to not use them....

We have not needed to up her pred in years. She is only on 2.5mg pred per day and her liver levels are still quite high. I don't feel that she is going to handle an upping of pred again. So I'm looking into all other options prior to doing so.
She has put on a little weight at the moment and weighs 16kgs. She was on 1/2 tablet tramadol twice a day which I have upped to 3/4 tablet. She no longer has omega oils due to her pancreatitis and is only on Rosehip canine joint supplement, as she can't have any of the seafood ones due to her intolerances/allergies. She is also taking denosyl.
There are a number of things I have considered trying in the past, but my vet has felt they were too much of a risk with pep. She is allergic to many plants and also has food intolerances which add extra concern when deciding on supplements etc to give her. At this point in time I'm feeling some risks may be worth taking as I feel upping pred is going to be an option that will lead down a bad path.

Has anyone tried arnica with their impa dog? I have been giving this to my son who just had surgery and it occurred to me that this may be an option to try with pep.

Also in the past I had considered magnets and cbd oil before, but my vet wasn't comfortable with either..
I feel that pep has injured her shoulder but impa relapse is always in my mind. Previously though when she has relapsed (which was a long time ago now), within days she would be so bad that she could not walk at all. It has been 3 weeks or so now and she hasn't got like that. Also she is still wanting to follow me even though she is in pain, she has no fever and she isn't hanging her head in pain doing the egg shell walk. They were all things she previously did with a relapse. I have an appointment on Monday with our vet for her to see pep and see what she thinks but I am concerned she will want to up her pred. So I'm trying to look into other options.
The last time Pep had trouble 2-3 years ago now my vet thought she had relapsed and continued upping her pred. She got really sluggish and we checked her bloods and her liver levels were through the roof. We dropped her right back and she was fine.

It's summer time here and this is the exact time of the year that pep first got impa and the time she has trouble with relapses, skin problems etc each year. Whenever we have hot days she always limps and struggles. Arthritis is supposed to be worse in the cold but she has always been the opposite.

She now has lumps coming on her in different places and with her age, cancer is a possibility but one I decided there was nothing to achieve by doing tests for. As she is too old and fragile to try put her through anything if we found out.

Another new problem is we are having trouble with her eyes being red and dry at the moment. She does have dry eye which I am still managing as I always had but the white parts of her eyes have started to become red. My vet looked closely at them and couldn't find any cause. So we had a round of amacin which improved it but it has now just come back again.

Anyone's experience on the use of arnica or any other thoughts of other options would be much appreciated.

[Jo CIMDA]

Hi Brooke and welcome back!

I am so pleased that Pepper has managed to achieve long term remission with IMPA.  It was a long journey for her and you.

From what you have written, it seems that this limp, and swelling around the joint, is isolated to just one leg and this indicates that it is more likely to be an injury or just old age - how wonderful that can be said about Pepper!

Personally, I wouldn't give more pred and if she is only on 2.5mg a day I doubt it is having much effect other than her adrenal glands won't be making as much of her daily requirement of glucocorticoid. So have you considered weaning her off the pred and going down the route of a conventional anti-inflammatory, such as Rimadyl or Metacam?  I wouldn't touch Previcox because that caused kidney failure in one of my dogs.   

If you would prefer to try alternative remedies, you could try Yumove (not sure if you can get it in Australia).  I know of many people who give CBD oil to their arthritic dogs, but it would be better if you had your vet's blessing.   

Arnica is a good remedy to promote healing but I don't know if it will help in this case.  Rhus Tox is a good homoeopathic remedy for stiff joints, so that might be worth a try or if you have a homoeopathic pharmacy in OZ they may be able to make a remedy just for Pepper.

Resting is essential when treating an injury but it is very difficult to control what Pepper will get up to when you are not around.

Do you give Pepper dry eye ointment?  If not then in the UK you can buy Viscotears from the chemist, and I would give those a try.

I do hope she improves very soon.

Lovely to hear from you.

Jo

[BrookeR]

Hi Jo,
It's nice to hear from you again. I hope all is well with you.

Yes pep has been on optimmune (cyclosporine) eye ointment for a couple of years or so now. I also regularly throughout the day put hylofresh lubricating tears in her eyes. Her body never likes this time of year and it is very dry here in australia this year in particular. We've also had heavy smoke from fires some distance away. Lots blowing around and lots of people have had trouble with hayfever and allergies, so I'm wondering if this has had an effect on her too. Possibly causing her red eyes. They have improved some the last couple of days and the air has also cleared from the smoke.

We saw my vet yesterday and she said the swelling in peps elbow could not be normal arthritis. She thinks that sort of level of swelling could only be caused by impa. I asked about cancer and she said it is very uncommon in the elbow where her swelling is. She also thought that with the amount of swelling if it were cancer than she doesn't believe Pep would be walking at all and would be in extreme pain. She suggested an X-ray which may show white coloured fluid if it is impa. She said fluid from impa is higher in protein and can show more of a white colour on xrays. If it were cancer there should be some sort of signs of erosion around the bone. Sorry that may not be the actual terminology she used but that's how I understood.

I asked what we would achieve from an X-ray? If it's impa we have to up the pred. If it's cancer we up the pred/pain killers. She said 'yes that's correct, unless you plan on cutting her leg off.' (Which I don't.) So I decided not to do the X-ray for now. I really don't like upping the pred but there didn't seem like any other option. I had upped her tramadol the previous night and it didn't help and she started to be a little sedated.
Her limp/walk had also gotten worse after I wrote on here. Not the true 'eggshell walk' but due to the pain swelling in her front elbow there was more emphasis on that leg.
I agreed to go up to 10mg once a day. This is under immune suppressing doses. But the last time she had a true relapse, not quite 4 years ago. That is the dose I gave her (even though our vet wanted me to give twice this). I tried 10mg and it took a couple of days but she came good at that dose. So that is where we are up to. Trialling 10mg of pred (once daily) for a few days with the 3/4 tramadol twice daily. If no response I may consider the X-ray. I'm not sure what else to do. Then I guess we go up pred more


One of her limp nodes in her neck was slightly more enlarged than normal, no fever and her other joints were a bit swollen but slightly less than the last time I saw our vet in September. At which point she had said her back hocks were a little swollen. But likely normal arthritis.

Our vet didn't think it was septic as there was no increased heat in that joint and no wound where contaminants could have gotten in.

Is there anything else that could cause an extremely swollen elbow? Could she have fractured it jumping off the lounge? She has a lot of muscle wastage in her chest, which is very noticeable seeming she is a staffy.

[Jo CIMDA]

Hi Brooke

Usually, IMPA will not occur in only one joint.  The typical presentation is swelling on multiple joints, and usually with a high temperature.

The dose of pred is now an anti inflammatory dose, so perhaps this will do some good and reduce the inflammation in the joint. You can only try.

If Pepper can have the x-ray without being put under sedation or a general anaesthetic then you may as well go for it if the increase in preds isn't effective.  It may show up the cause.

Euphrasia is a homoeopathic tincture that can be use to soothe the eyes.  Just a couple of drops in cooled boiled water can help but if Pepper's problem is immune mediated then it probably won't have much effect.

I do hope this increase in pred will do the trick.

Jo

[BrookeR]

Hi Jo,

Yes that's why I have been so puzzled that it seemed just to be that joint in particular.
So I decided to go ahead with the X-ray to see what was going on and if there was a fracture. Once i decided and booked the appointment her swelling began to decrease and she started gradually walking better. She still has some swelling and is still dipping her head when walking on that leg but even during the day while she was at the vet our vet noticed a decrease in swelling. She is only at 10mg once daily which she has been on for 4 days now. Unfortunately they sedated her (with pain relief). I really don't like doing that but felt like it was important to see what was going on before upping the pred. As I don't feel her liver will last long with a much higher dose.

Unfortunately the X-ray showed up a quite large area missing from the outside edge of her elbow. Like a bite had been taken out of it. A big corner piece missing   There was also a strange marking almost looked like a little hole/chip midway down below her elbow & before her wrist, in the centre of her bone that only showed on one X-ray. My vet has sent to a specialist to get their opinion on whether they think cancer or erosive poly arthritis. I was only reading up again on this the previous night prior to her X-ray. There is a picture of a staffy in michael j days book with rheumatoid arthritis and it always catches my eye. I did have X-rays done of pep a few months after she initially got diagnosed with impa to check if it looked erosive but at that point everything looked fine. I also mentioned about doing the blood test to check for the rheumatoid factor back then, but I don't think we ended up doing it as the vet at the time said they didn't believe that was it and I don't know if the test was even available in australia then.
My vet also took a small amount of fluid from peps joint (not enough to make the noticeable decrease in her joints swelling) while she was sedate. Normally she would ask me prior to doing this but when I came to pick her up she asked did I want to send it off. Since it was already collected I agreed. She wanted to see if that could give more of an idea if the cells were cancerous or just likely impa.

So we are now waiting to hear back on the results from the fluid taken and the specialists thoughts on her xrays. We have have decided to stay at 10mg once daily until we get results. My vet said she more thinks it's impa and erosive rather than cancer. But it really seems to be that one joint that is causing trouble which is not consistent with impa. I know erosive poly arthritis is really rare but also cancer in the elbow is rare too. But this is pepper and she seems to like going for the more rare diseases

My vet wants to try arthritis injections with pep but I feel the risk is too high. But if this is erosive impa we would have to assume all her other joints will be bad too and therefore I think we need to take a risk and try give her some joint supplement to try even slightly help. She is only on rose hip canine for her joints at the moment which is only anti inflammatory and doesn't have any effect on trying to prevent/heal damage. So my vet has given me 4cyte to try. We are waiting until after the weekend before trying just in case. It has rosemary extract in it which in the past I had read could cause seizures. My vet assured me she doesn't feel there being a problem and this is the best option to try.
I was rereading over my old notes last night and found some that said MSM (found in egg shells) given to dogs with RA showed no cartilage degeneration. So I want to mention this to our vet. I did at one point give pep ground up egg shells at a certain dose. So I'll need to try find my notes on that. We have had to stop her fish oil due to her pancreatitis.

I really value your feedback Jo. With your vast knowledge it greatly helps to have another opinion and some extra knowledge from someone who follows and sees the story of all these dogs with impa and other similar disorders. We are forever great full for all your help over the years

[BrookeR]

The specialists said peps X-rays could be erosive poly arthritis or cancer. They said there was shadow down towards her wrist which looked like fluid consistent with poly arthritis. The small strange area in the middle of her bone they didn't see as anything of significance at this point. They suggested bone or tissue samples to be sure, if joint fluid was inconclusive..
The joint fluid sample taken came back not showing any cancerous cells. My vet didn't write on their form peps history of poly arthritis so as not to taint their response. The pathologists report said there were no cancerous cells and increased neutrophils which they suggested as being suspected poly arthritis.

The swelling in her elbow went down when we went to the vets on Thursday then it went back up again and she struggled to walk at all on Friday. It was also really hot Friday which is when she has always had trouble walking even prior to what's going on now. By Saturday she was walking better. The swelling started to go down Saturday arvo and was significantly down Sunday. She was better again Sunday with her walking and today once she was walking was the best she has been in a while. Still dipping her head and having some little stumbles when getting up but quite better than she has been.

Tomorrow we are forecast for catastrophic fire danger where we live and we live right on the bush. I am very apprehensive about tomorrow. I'm worried about our family, our house, our business (which we run from home) and Pep. Pep is normally terrible in the heat (in terms of not being able to walk well) and she doesn't handle change or stress well. I'm worried how she will be if we have to go evacuate. So i have decided with my vet to slightly increase her pred more and reassess in a few days when the fire danger has subsided some. Her liver won't handle increased pred for long but I can't afford to put her on other drugs like cyclosporine again and she is too old to put her through that again anyway. We have been holding off increasing in hopes she will improve. But with the catastrophic weather forecast for the next few days I think we should try increase, to try get her more comfortable with all that could be going on. If we wait too long  and don't go up we may have to go up even higher in dose and then we will have less time due to her livers health. We also need to be concerned about her pancreatitis.
We are in a bad place right now with no good options

[Jo CIMDA]

Oh Brooke, I am so sorry all these things have come at once.  I have seen on the TV,  the fires in Queensland and it must be such a worry for you, on top of all the investigations to find out what is wrong with Pepper's leg.

I do think a slight increase in pred is a good way to go.  Did the blood results show a marked high level of liver enzymes?  I hope not, but as you know the liver can take some pounding,  producing exceptionally high enzymes before it becomes a significant problem.  I hope the blood results show that you have room to increase the preds before having to truly worry about her liver.  I know you give liver support, so this should help.

It is so frustrating after having x rays done that a definitive diagnosis can't be reached but I have always been under the impression that cancer is not difficult to diagnose, so the fact that it is not obvious on the x rays  has to be a good thing for Pep. One of my dogs had cancer in the bone on his foreleg,  just above his wrist, and the pain was excruciating for him, and it was not a swelling that reduced because it was bone mass, not fluid,  so again I am hopeful that this is not Pepper's problem. 

From the feedback, it is likely to be an isolated joint problem, maybe due to older age, or the start of IMPA.  Rheumatoid arthritis is very rare and it also occurs in more than one joint.  I know the photograph you describe in Prof Day's book, and it is quite alarming. 

All you can do is to try the increase in pred and hope it brings Pepper some good relief.  Perhaps restrict her exercise for a week.  You have bigger things to worry about at this time.  I wish you safety,  for you and your family, and your neighbours and pets, and if you are evacuated then I hope you can return home very soon.

Take care
Jo

[BrookeR]

Hi Jo,
Unfortunately it looks like this dreaded fire danger weather is not going to let up and they are predicting more on its way next week. 

I have an appointment on Monday to do bloods and check Peps liver levels. We will see what that comes back with, I am expecting not great results.

I am very sorry to hear that one of your dogs had cancer and was in terrible pain. Your description makes sense to me and makes me less inclined to think that's what pep has.

I have been wondering and reading more about infectious (septic) arthritis. Pep didn't have a red area that was particularly hotter over her joint or any wounds so this was disregarded. But I have been reading (not sure how reliable the info is as it's from the internet) but it can be caused by

• penetrating trauma;
• haematogenous spread;
• ear infection;
• gastrointestinal infection;
• urinary tract infection;
• pyoderma;
• anal sac infections;

I also read that 'It is well recognised that pre-existing joint disease can predispose to haematogenous spread. Examples of this include osteoarthritis, immunemediated joint disease and blunt trauma that can precede the infection by a few days.''
Typical physical examination findings are:
• lameness – more chronic cases may be mild
• warm swollen joint with pain on manipulation;
• redness or discolouration of overlying skin;
• joint effusion;
• local lymph node enlargement;
• muscle atrophy; and
• monoarticular.

All of these she had except the joint didn't really feel a lot warmer than others and it wasn't red. Pep has brown skin and tan hair covering her elbow so I'm not sure how you could see red. Can we rule septic arthritis out based on this?
Is a trial of antibiotics an option?

I have remembered after reading the above info. At our most recent vet appointment that was maybe a few weeks prior to this all happening. Around peps bottom she had a little cut and bit of swelling. We just left it to monitor as she has had trouble with her anal glands in the past and has had times where she has gotten pussy and swollen around her bottom when she has been dragging it on the pebblecrete.
Is it possible she could have septic arthritis or am I reading too much into it? The swelling has reduced but could the pred do that? She is still in pain on that elbow and dipping her head when she walks. We are now on 1/2 tramadol twice daily and 15mg pred twice daily.


I have also tried to find info about erosive poly arthritis which has been difficult. But I came across a list of types and one being Felty's syndrome. The info mentions an enlarged spleen which pep has. When we had an ultrasound done a number of years ago early in her diagnosis the specialist found this and at the time said she wasn't sure if it was significant. Felty's syndrome also involves rheumatoid arthritis. Pep was diagnosed with impa and now it is looking to be erosive. I'm not really familiar with the difference between the two. Rheumatoid arthritis gets treated with immune suppressing drugs too. We never tested pep for the Rheumatoid factor. Could her impa have been rheumatoid arthritis? I didn't think so but don't know enough about it. I thought I'd read you never achieve remission with rheumatoid arthritis and it requires lifelong drugs and not a good prognosis. Pep was on such a low dose of pred there for ages so that wouldn't seem to me that she could have had rheumatoid arthritis.
I might need to give the reading a rest for a bit as it can be easy to read to much into things.

[Jo CIMDA]

Hi Brooke

Septic arthritis commonly occurs in more than one joint and there is always a hot swelling, as would be expected if there was infection present.  So it seems unlikely that Pep has this form, also I would presume that any infected fluid would have shown up on the small amount of synovial fluid the vet took from her joint.   Personally, I wouldn't use antibiotics unless Pep needed it.   I think the swelling around the anus is not related to Pep's joint problem.

Prednisolone is an anti-inflammatory drug in the right dose, and it seems Pep is on that dose, and it is not specific to any particular area, so perhaps the increase in pred could have reduced the swelling around her bottom.   Pep doesn't fit in to the clinical signs of Felty's syndrome, so I wouldn't worry about that, and her IMPA wouldn't have been Rheumatoid arthritis.  The presentation is different and Pep doesn't have deformed legs etc.

DVJM360 is a very good website for all veterinary conditions, but I wouldn't over read because it will just drive you crazy.  See this link:


http://veterinarymedicine.dvm360.com/recognizing-and-treating-immune-mediated-polyarthritis-dogs

I do hope you escape the fires.  Stay safe.

Jo

[BrookeR]

Sadly it seems we are nearing the end of Peps journey .... I saw our vet yesterday and these were her thoughts (which I had felt was coming). We are now going to weekly visits for her to monitor Peps condition.

Since last writing on here we decided pep had been relapsing and upped her pred. Her swelling went down and limp improved. She was still not walking right though and had some limp. So I began giving her 4cyte for her joints and started MSM. After starting the msm she began walking without any limp anymore, she was greatly improved. However Pep wasn't tolerating the pred this time and was experiencing side effects that you would normally get at much higher doses. She got a urine infection before Christmas which we treated then came back and we treated again but within days of going off the antibiotics she began showing symptoms again so yesterday I took her back and the infection is still there. We have sent away to culture and see if it has become resistant to the antibiotic. She takes tribussen this is the only one we have used with pep in years as she is allergic to cephalexin and we have been worried others are too closely related. So I don't know what we will do.
Added with the urine infection which came back with a vengeance in January we also had a bout of pancreatitis. She had been getting sick in the night and getting up every few hours, licking her lips. Food was the only thing that settled her. We started her on antacid and then within a few days she began vomiting and tests confirmed pancreatitis and bad urine infection.  Pep has lost a lot of weight/muscle. We have got through the pancreatitis bout but she is continuing to loose weight at a fast pace. She had been having muscle wastage gradually from being on the pred since she was 7 (this year she turns 13). But it has just increased at a fast pace. I thought the up in pred had caused it. We were only just at anti inflammatory doses but she seemed to be having side effects of much higher doses. But we have dropped back some and still she is dropping weight. She is down to a mere 13.3kg. She is just skin and bone her front legs now are bowed at the elbows. She is starting to have trouble walking and is weak in her back end. Her back legs have been slipping out on the floor and she has been stumbling on them. Yesterday she started to limp a bit on her front leg. My vet thinks she is relapsing again. We had got her stable prior to her pancreatitis attack. Her diet is cooked kangaroo mince, broccoli, carrot, beans and sweet potato and nothing else. So it can't get much more low fat. we thought the pred may have caused the attack and so dropped another 1/4 of a tablet per day. My only other thoughts were the kids left some food laying around that she got (however they are normally good as I always hound them how important it is not to leave food pep may get) or she ate cat poo from the cat that sneaks in our yard from next door at night. 24th jan was her pancreatitis bout, urine infection and when we dropped the pred 1/4 of a (5mg) tablet. Normally we don't drop by 1/4 s but she is extremely sensitive so we thought this the best option.

We haven't gone looking for cancer so can't rule that at as a cause. I know she is now almost 13 but the drastic weight loss seems more like something else going on. I have asked my vet can we give digestive enzymes to see if that helps. She believes that pep doesn't have epi because her poos are perfectly formed. But I have read digestive enzymes are good supplemented for old dogs. She previously has said no to trying but now says we are at the point where risk is not so important. Yesterday we started her wearing  a magnetic collar and also gave her a zydex injection. We had these reserved as things we thought were too risky to try in terms of triggering impa. But now it's at the point where time has run out and the risk is not so great anymore. She is fading away.
I know I have had so much time to prepare for this, but no amount of time is enough to prepare for loosing your best mate who you have been with 24 hrs a day 7 days a week for the past almost 13years. We have been through so much together and she has always been there, even when I go to the toilet.
I'm so grateful I have been able to work from home all her life so we have spent all that time together but it's so heartbreaking now coming to this point and the thought of how big of a hole will be left.
I'm broken

[Catherine]

I am not sure whether I have suggested this before to you, but giving a daily cranberry extract tablet may help ward off urine infections. I have certainly found it has helped with my dogs. Also Canikur Pro Paste is good for upset digestion although I realize the pancreatitis needs something stronger.

Has Pep had any recent blood tests? It could be the start of kidney failure, but sometimes that can be slowed down with diet and medication.

I can identify with you on being prepared, but not being ready to make that final decision. It is so difficult, for you seeing your beloved dog becoming thinner and maybe not wanting to eat but at the same time still has quality of life. So I would go with anything extra the vet can give to make her feel a bit better.

[BrookeR]

Thanks Catherine. I actually mentioned cranberry juice to my vet yesterday but hadn't realised there was cranberry extract tablets. She will be calling me to discuss the results of the urine culture when it comes back so I will further discuss this with her. Thank you.

Pep still has a ravaging appetite. I have always weighed out her food and so she always has the same but is loosing weight. I may try upping her daily intake slowly perhaps she needs more now as her body may not be absorbing nutrients from her food so effectively anymore. But I worry about giving her too much in case her pancreas flares up again. She can't get anymore of a low fat diet though. I haven't heard of canikur paste, I will look into it. Shes not vomiting now (she was a bit with the pancreatitis) and her stools are perfectly formed, she just keeps loosing condition. I suggested doing a worm test on her because we have never given her work tablets since she was diagnosed with impa. But my vet said that if her poos look fine she can't see worms being significant enough to cause this.
Yes she had bloods done again last week and her liver and kidneys all seem fine according to my vet as that was one of the first things I questioned too.
Thanks greatly for your reply, some more for me to think about.

[Catherine]

The cranberry juice usually has sugar in it. These are the type:  https://www.naturesaid.co.uk/cranberry-5000mg.html I give one daily, cut up and mixed in with the dog's meal as they are a bit sharp tasting! If there is any sign of a urine infection I will give another one during the day. But if the dog has not had them before I would suggest starting with either a half or quarter for a few days just to make sure they do not cause diarrhoea!

Also at the first sign of a UTI I start the dog on homeopathic Cantharis tablets. This was some advice I got from Jo some years ago: "Cantharis is really good for cystitis and if there is blood in the urine then perhaps the 'acute' treatment protocol should be used.  [/]"Give one tablet every 15 minutes for three hours, then one tablet hourly for the rest of the day.  After this give one tablet three times daily for three further days or until all symptoms have disappeared". from: Heal Your Dog the Natural Way by Richard Allport.  FYI, the chronic protocol is: "Give one tablet three times daily for one week , followed by one tablet twice daily for three weeks".

I keep some Canikur Pro Paste handy although, thankfully my dogs rarely get diarrhoea. I thought it was just for diarrhoea but I have found it good for when they have been sick, to give it for a few days.

I am glad her kidneys and liver are fine. It may be some type of malabsorption.

Good signs, her still wanting to eat and her poos being solid. If you can not see any evidence of worms that is good too. The only thing I will say is to rule out tapeworms. These are a lot harder to see, sometimes they just look like a grain of rice in your dog's poos.

With her meals, perhaps you can try giving her several smaller meals a day.

[BrookeR]

Thanks greatly for your help Catherine. I have made a note for myself about the cantharis & canikur paste.
I spoke with my vet yesterday and the urine infection is not resistant to the antibiotic pep is on. So we are starting it again and doing a longer course. She was fine with me starting the cranberry too. I actually found a place here in australia that sells it in powder form. It's the same place I get her msm from. Greenpet Cranberry Powder it is made from 100% pure human-grade freeze-dried cranberry powder. No additives or sweeteners added.  Suitable for dogs, cats and horses. So I have ordered some of this. My vet is still not keen on giving her digestive enzymes and is sending me info to read about it. Which I assume is info trying to convince me to not use.

After reading your initial post I thought more about peps food intake and realised that back last year around November when she first starting having all the problems with her elbow. I had thought she had put on extra weight and maybe that was adding stress to her joints so I cut back her food by 50g-60g per meal. I feed her 3 equal meals a day and also a smaller supper. I have been doing these spaced out meals since she got impa to try help her liver. Normally she also snacks on kangaroo mince throughout the day but since the pancreatitis I have only been giving her vegie water (the water her vegetables have been cooked in). I had forgot that I dropped her food intake and hadn't even thought that this decrease in food back then could be causing this wastage or adding to it if there is something else. As it was some time ago I cut her back and so much has been happening since. Last time she got pancreatitis I cut all carob drop treats and had to up her meat and veggies intake. I had to up it considerably to get her back to a healthy stable weight.

I upped her lunch and dinner meal yesterday but then this morning and through the night she was lip smacking again and yawning like she was prior to her pancreatitis attack. So I'm worried her pancreas may not handle the food increase. Maybe I need to try do a little more gradually or add more smaller meals and space out more? Not sure whether it would be better to give the pancreas time to rest between bigger meals or to give often smaller meals?

There is no more of a low fat diet I can give her to help her pancreas, but I need to give her food also because it looks like I'm starving her and low fat diet isn't going to add weight especially when I can't up the quantity because her pancreas keeps getting mad. The digestive enzymes are the only thing I can think of. What else can be done to help the pancreas?

[Jo CIMDA]

Oh Brooke,  I have read through your posts and Catherine's very useful replies and I am so sorry you are having these problems with Pep.

I do wonder if she should be weaned off the preds, and if necessary this should be replaced with another drug (Avoid Previcox).  Preds can cause pancreatitis and it certainly won't be helping.  As you know it also causes muscle loss and in some breeds they lose weight when they are on preds, so an alternative might be a consideration.  I have also known older dogs not to tolerate the side effects of preds as well as they did in the past.

The good news is her kidney and liver values are good and this makes me think that whatever is the root cause of her current clinical signs, it could be resolved.  My concern was kidney failure but that is not the case. Pancreatitis is a tricky one to deal with sometimes - acute pancreatitis is urgent and very different in terms of how you respond, to chronic pancreatitis - and I don't see that enzymes would be a problem because she would likely just pass any excess through - and they might just help.

I have a book called:  The Pet Lovers Guide to Natural healing for cats and dogs by Barbara Fougere BVSc

'Pancreatitis - what you can do'
For chronic pancreatic problems,a highly digestible, low-fat, low fibre diet is recommended.  Protein should be of high quality and easy to digest.  Give small amount of food frequently rather than one big meal daily.  Each meal should be supplemented with digestive enzymes.  Low fat recipes should be fed under the supervision of your veterinarian.

Natural therapies:
Supplements:
Powered digestive enzymes
Cobalamin
Vitamins A, D, E, K, (these fat soluble vitamins may be low in a low-fat diet)
Vitamin B Complex or a multivitamin and mineral mix

Bach Flower remedy:
Rescue remedy is appropriate for pancreatitis: Olive and hornbeam for recovery.

Homoeopathy
Acute attacks Iris Versicolor 30c


My daughters dog had terrible problems with pancreatitis - usually acute - and Iris Versicolor  30C really worked, if she caught it early enough, but that might vary from dog to dog.

It sound like you have a vet who is will ing to work with you, so it might be worth discussing some of the above.

I do hope Pep can stabilise very soon and get back to he normal self again.

All the best
Jo