Pancreatic cocker Spaniel now diagnosed with IMPA and on steroids

[melhardy71@gmail.com]

Hi

I am hoping that you can move my post to the correct place. I have a 1 year old cocker spaniel who was critical in early August with pancreatis luckily after 5 days he was allowed home with antibiotics, painkillers and a diet of Royal Cannin GA low fat. We were also told that he was not under any circumstances to eat anything else but this no treats or anything. they also think that this was caused by some kind of allergy in his small intestine which then caused the pancreatis which unfortunately led to Sepsis which is why he was critical. So Zak came home much thinner but alive. Moving on two weeks from that Zak statred to limp and hold his back legs quite low, he also stared into space alot and unresponsive while stood on the spot apparently unable to move. Over the next 48 hours he got worse and slept for 16 hours straight with lack of movement to any joints and alot of licking of lips. So he went back to specialist and while there all his joints started to swell etc. so they thought it could be meningitus so decided to take the risk of a spinal tap to get the correct diagnoses for him. The fluid came back and IMPA was diagnosed. He is now on steroids and the dosage has been dropped by half now after a week. We have also been advised to change his food to a low fat hypoallergenic food which he is now on. In Zaks case they think that his small intestine had problems which led to pancreatits which went into sepsis which in turn meant that some toxins got into his fluids and caused the IMPA. But they are hopeful that when he gets to about 2 he could grow out of the IMPA and will just be left still pancreatic. To deal with a pancreatic dog is hard as the relapses can be critical but now with IMPA on top of that and trying to get that in remission with medication and keeping him low risk with pancreatis I am finding quite daunting. An advice would be much appreciated and apologises for any spelling mistakes.

[melhardy71@gmail.com]

Oh should also of mentioned when the small intestine/pancreatis happened he was being sick and losing a hell of alot of blood from back end which until he was moved to specialist place they couldn't stop which is why they are pretty positive that this all started from his small intestine.

[Jo CIMDA]

HI Mel

Poor cockers, they have a genetic predisposition to getting pancreatitis and although some episodes can grumble, at other times, like Zac experienced, it can be life threatening and very difficult o bring under control.  Keeping him on a low fat controlled diet and keeping his weight down is the best thing. 

My granddog (my grandchildren's cocker) had pancreatitis a couple of years ago and after spending 17 days in the hospital and the RVC he survived and my daughter was  £6,000 poorer!  He has had a few flare ups but thankfully all have been caught early and a major crisis avoided.  So, unfortunately, this is a genetic predisposition that many cockers and their owners have to contend with.

I do wonder if it all triggered off IMPA.  What dose of steroids was Zac on?  I hope the specialist has put Zac on something to protect his stomach.  If he isn't on something like Antepsin, omeprazole or ranitidine then you should ask your vet about it as you don't want the steroids to cause another bout of pancreatitis. Steroids cause an excess of stomach acid and by giving a gastroprotectant you may avoid stomach issues.

I hope his IMPA has improved.  Check out the drug protocol by Prof M. J. Day in the files.  This is an excellent guide.

Good luck
Jo

[melhardy71@gmail.com]

Hi Jo thank you so much for the reply. Unfortunateley because of the small intestine problem which started all this he is unable to continue of the special Vet Diet low fat food and has had to move to the hypoallergenic moderate calorie one. He also isnt allowed to eat anything else atall for the next 6 weeks but that. He cant have the wet variety of it because the fat content is too high. His steroid dose has now been dropped down as 2 x 5mg once a day so it has halved from what he came home on. He isnt on anything to protect his tummy as they are still concerned about his small intestine so we are still in the early stages of getting the medication right. However he is back at the specialist tomorrow morning so I will mention it then. Hi back leg still isnt right and he is making a very slow recovery from the IMPA movement wise. Also with him only being 10 days into the pancreatic recovery before he got the IMPA and needing a spinal tap and other joint drains his bosy has been through alot so they have said it could take a while for our Zak to be back to what we are used to (a complete nutter who does everything at a 100 miles per hour). they do think that when the small intestine became bad it triggered the pancreatis and because of all the blood he was losing from his back end and going into sepsis some of the toxin got into his fluids and caused the IMPA so on a positive note this illness he could grow out of when he is about 2 years old. They have said they will monitor his muscle deteriation, liver and pancreas very carefully because of the steroids though with regular ultrasound scans on his abdomen and bloods. I just still find it strange that all this started with what everyone thought was a bad tummy then he had a limp and ended up with fluid on all his joints and spine etc 2 weeks later and now has another condition to contend with. I have 2 other dogs and six cats as well and the pancreatis was a worry with differnet foods for different animals etc. so the other 2 dogs are now on a low fat diet ( as my other cocker is rather chunky but Zak has always been skinny) so any accidents will at least be low in fat even though not hypoallergenic. Just finding it all quite daunting as he is only 1. Just like to hear about other people with pancreatic dogs/ IMPA dogs to see how they cope. We can't take him out for another week at least yet but because of the steroids he cant be vaccinated with his booster till we do bloods in another 8 weeks so we have been told not to let him go where alot of dogs go as he is open to infections as well at the min...Glad to hear that your granddog has survived pancreatis and only had a couple of flare ups that have been caught in time. We panic at any slight change in him even if he just has an extra long nap. If only they could talk it would be so much easier...

[gschellinger]

They certainly are a worry when they get so many things going on. One affecting the other and the whole even affecting us as caregivers. I sure hope things settle down and your pup can get on with being the pup he still has in him.  My Lola was only 1 when she started on the road of illness. She had so many things, including IMPA IMHA and others! She eventually got pancreatitis from prednisone. It is so scary and as bad as some of the AI issues. But she lived, against so many odds. She has other health issues now, not the immune disorders, and is no longer (for a long time now) taking pred.

Best wishes.
gail.

[Jo CIMDA]

His steroid dose has now been dropped down as 2 x 5mg once a day so it has halved from what he came home on. He isnt on anything to protect his tummy as they are still concerned about his small intestine so we are still in the early stages of getting the medication right. However he is back at the specialist tomorrow morning so I will mention it then.


Hi Mel

They may be concerned about the risk of preds causing pancreatitis but I am surprised that they have lowered the preds after only one week when the initial duration of dose is usually anything between 10-21/28 days.  I had thought that a loading dose of 2mg/kg/12hrs may have been given (Immunosuppressive dose prednisolone 1-2mg/kg/twice a day, usually starting at 1mg/kg/12hrs) and therefore it was lowered to 1mg/kg/12 hrs but this doesn't seem to be the case. Dogs that are taken off the immunosuppressive dose too early run the risk of a relapse. See the M. J Day drug protocol in the files. A gastroprotectant is important for any dog on this therapy but especially one who is prone to pancreatitis.


they do think that when the small intestine became bad it triggered the pancreatis and because of all the blood he was losing from his back end and going into sepsis some of the toxin got into his fluids and caused the IMPA so on a positive note this illness he could grow out of when he is about 2 years old.

Does Zak have septic arthritis or immune mediated arthritis? The synoval fluid analysis from his joints should have differenciated between the two.  I can only imagine that he has IMPA otherwise they would have treated with antibiotics and not steroids.  What could have happened is the sepsis triggered off an immune response which targeted and infiltrated the joints causing IMPA.  It is expected for a dog with IMPA to ''grow out of it' or for it all to settle down and achieve long term remission within a few years but relapses can happen and often do, especially if the treatment regime is not correct or the dog is weaned off the steroids too early.

I have 2 other dogs and six cats as well and the pancreatis was a worry with differnet foods for different animals etc. so the other 2 dogs are now on a low fat diet ( as my other cocker is rather chunky but Zak has always been skinny) so any accidents will at least be low in fat even though not hypoallergenic. Just finding it all quite daunting as he is only 1. Just like to hear about other people with pancreatic dogs/ IMPA dogs to see how they cope.

You seem to have grasped the pancreatic situation very quickly.  Zak is lucky to have you.  My granddog cocker, Woody, is so greedy and he will steal food anytime he has the opportunity to.  Cockers do get AI disease as well, but Zak is very unlucky to have pancreatitis and IMPA. 

We can't take him out for another week at least yet but because of the steroids he cant be vaccinated with his booster till we do bloods in another 8 weeks so we have been told not to let him go where alot of dogs go as he is open to infections as well at the min...We panic at any slight change in him even if he just has an extra long nap. If only they could talk it would be so much easier...

It is best to keep him away from anywhere he could pick up an infection whilst he is on high doses of steroids.  I presume he has had his puppy shots and it may be that he does not need any further vaccinations.  A simple blood antibody titre test will be able to show if he has adequate antibodies to the diseases you vaccinate against.  Also Vaccination is known to have the potential to induce IMPA in some dogs so, please take that into consideration when making your decision whether to vaccinate again or not.  Most people with AI dogs don't vaccinate again, because it challenges the immune system and can cause a reaction, but you have to research this and make the decision yourself. Personally, I think to vaccinate in 8 weeks time would be unwise as it is usual for dogs with IMPA to be on a tapering dose of steroids for at least 4-6 months and it is not uncommon for a dog to relapse one or two times and it would be prudent not to vaccinate during this time.

Good luck tomorrow

Jo

[melhardy71@gmail.com]

Hi thank you so much Gail for your message and Jo. I will pop an update and no doubt more questions when I get back from the specialist tomorrow. He started on press of 2x 5mg twice a day he started them on the Monday and it was lowered the following Monday to 2x5mg once a day. He also came home with painkillers for afew days. It is definitely immune medicated poly arthritis. We get the rest of the results from bloods tomorrow as they took 10 days to process. They did say that the fluid was cloudy that came from his joints because at first they thought it was meningitis but then when the first lot of tests came back they diagnosed IMPA.  they did mention Jo though that they would be very careful with the press because it was only 2 weeks since his pancreatic attack and sepsis. They are also going to do an ultrasound next month to check how the pancreas is looking as well as bloods to check his vaccine levels and folate levels etc plus keeping a close eye on his liver. Hopefully find more out tomorrow and I will ask regarding stomach protection as well. I have a list of questions on a sheet of a4 lol.

[melhardy71@gmail.com]

It sounds like your Lola has been through the mill with illnesses. Hope her health is manageable for both of you. It is very upsetting to see your dogs so poorly when you can't help cure them. Plus my ickle cocker doesn't help himself he will nick anything that's not up high and eat it. It's like having a toddler again everything up high bottom shelf of cupboards and fridge empty in case he gets his head in. He is worth all the worry though wishing you and Lola well x

[Jo CIMDA]

Hi Mel

I fully appreciate the importance of getting a balance because of the high risk of pancreatitis -  a very tricky situation -  but the reality is, and anecdotal evidence supports this, if the steroids are lowered too quickly the dog will relapse because it is usually takes 3-4 weeks for the immune system to calm down and return to normal.  If the steroids are reduced too early all that happens is the body starts to increase production of the immune cells that are destroying the synoval fluid within the joints and the whole process starts again and the dog has to go back to an immunosuppressive dose for 3-4 weeks.  You might ask your specialist if adding another immunosuppressive drug would be prudent because this allows the steroids to be lowered more successfully.  The problem is all of these drugs have the potential to cause tummy upset or pancreatitis.  You could ask him about using Azathioprine or Atopica. A gastroprotectant should certainly help and limit the risk.

Great that you have a list of questions.  That doesn't mean that you are trying to tell the vet his job but sometimes asking questions can get them thinking outside of the box and that is never a bad thing.  What specialist are you going to? Is it in the UK?

Jo

[melhardy71@gmail.com]

Hi Jo yeah the specialist is at Chester. She specialises in internal medicine and is the same lady that dealt with his pancreatitis so she knows Zak quite well now. We went there last year when one of cats had an MRI scan for his nose to see what was stuck in it. Unfortunately it was diagnosed as nasal cancer and because it was attached to the back of the eye slightly he couldn't have chemo or radio therapy but he has been on palliative care since then and yep good old steroids and is still here today. He is only young as well but he is giving the cancer a run for its money. Apart from the obvious side effects of steroids peeing alot he is doing ok. I do like the surgeons at Chester because twice now they have been really good with Zak and so far nothing they have done has had a bad outcome for Zak as yet. I touch wood as I say it though. He still has 10mg press per day so they did say that the tapering off the steroids will be very gradual. I am very nervous about him coming down from 10mg per day to quickly though and she has stressed this alot in his discharge notes. Fingers crossed things become clearer tomorrow. Plus they did give me 2 months worth of preds in the bottle.

[melhardy71@gmail.com]

Well back from Chester. Zak id doing really well condiering how early in his revoery we are at. He is not in remission yet as he still has kick out on one of his back legs when sitting etc. Also due to his high pain threshold as usual he didn't give them much feeback just wanted to be his hypo self and jump on there heads. He is staying on the steroid dose of 2x5mg once a day for 3 more weeks then we go back. If he still isnt in remission then other immune drugs will be given and steroids can then be lowered so he doesnt stay on high steroid dosage. If he is in remission then they will slighlty alter his steroids down but just a little. They are pretty convinced all this was caused by food allergy issue with the small intestine, so he is staying on Hypoallergenic moderate calorie food only for next 8 weeks at least. That way it will help keep is small intenstine settled and rested which should stop pancreatic relapse. He can have 5 min walk each day then gradually increase to 10 mins. If he still improves over next couple of months then they might ultrasound his tummy to have a look at his internal organs then maybe introduce white fish or turkey into his diet and see how he copes. I am not to concerned about this though as he can stay on the hypoallergenic food if thats what is best for him to stop any relapses of tummy/pancreatis or IMPA. His weight is still low but they arent to concerned at the min getting him into remission and keeping the tummy rested is priority at the min. No signs of the side effects of the steroids as yet. The reason he isn't having any tummy protector is that because they know he has a bowel issue already which started all this off the steroids are known to help with bowel issues and he wont be on the steroids long term as he will switch to other drugs once in remission then taper off those. So no bad news today we just carry on as we have been, dealing with vigilance with food etc and keeping him rested so he can get the IMPA in remission. So we go back again on the 11th aslong as we dont see any set backs or complications before then. But she was very pleased with his progress and movement he now has compared to how bad he was. 

[Jo CIMDA]

Hi Mel

It sounds as if you had a very positive meeting and that must be so comforting for you.  All you can do is to carry on with your specialists recommendations and fingers crossed he will reach remission. 

It is so difficult when a dog is prone to pancreatitis.  I don't understand why he can't be on a gastroprotectant  because the steroids will help the bowel anyway with or without a gastroprotectant. A gastroprotectant lines the stomach and helps to remove the excess acid produced by the preds, which also prevents stomach ulcers.  Any dog on steroids has a risk of pancreatitis.  At the end of the day you trust your specialist, and so you should, so you have to go with it. 

I would feel the same as you and if Zak stays on the hypoallergenic food and it prevents another pancreatic attack then I would be happy with that, and it's better he is on the light side.  It is a struggle to keep weight off my granddog and that is not good with his predisposition.

I'm sorry your cat has nasal cancer, but he seems to be doing very well.

Jo

[melhardy71@gmail.com]

Hi just thought I would pop an update here on Zak. He has had his full boods done and is showing good immunity still to parvo etc so we dont need to think about the booster issue for another year, his B12 results are normal so another positive and his folite (not sure if thats the right spelling) are above normal which could show bacteria overgrowth but there aren't to worried about that. So so so far the pancreatis is under control along with the bowel allergy problem by Zak only eating hypoallergenic food and absolutley nothing else. With regards to the IMPA and his steroids dosage he is now down to 1x5mg tablet a day and it has been a month now on this dose and so far so good. He has gained a little weight and is now 12.2kg so we are trying to keep his weight at this. As the weather is both cold and wet we aren't taking him out as much as we would like as getting cold in the joints we have been told could effect him as it is still classed as early days, also havent sent him to groomers etc as it is a small ebvironment with other dogs and dont wat him to catch anything while his immune system is compromised. When hwe have let Zak off lead for a play with the other two dogs I have muzzled him and put a do not feed coat on him to deter other people from being tempted to give him a treat and to stop him eating things he may find before I can get to him. Because he is constantly starving the leave it command isnt working quick enough. The only woory we had was that for two days last week he drank and peed for Britain and for Zak that was unusual as he is always clean in the house but it seems to of cleared up on its own however if it does come back again he will go in for another blood test just to be safe. So my ickle boy is doing very well and might lower his dose after next check up after xmas if everyone still happy with him. He does now have the cone shape boney head and pot belly due to the steroid use but even though his head won't reverse back his pot belly should once he is off the preds in 3-6 months time. Hope all your pets are well and if that is not the case then I wish them well and that things improve.

[Jo CIMDA]

That's really good news.  I expect the vet will put Zac on to every other day dosing next and then you will see a difference in his pot belly etc.  Hopefuloly his head will fill out with fat and he will have a more ounded head shape.  It is not unusual for dogs in preds to get urine infections so it he starts weeing a lot again then it might be worth taking a urine sample to the vet  for them to test.

Great news.

Jo

[Penel CIMDA moderator]

Good news about Zac, thanks for letting us know how he's doing.  Fingers crossed he continues to improve x