My Annie, 15 1/2 pheochromocytoma - Annie is now an angel running free

[BestBuddy]

Metacam is a great drug but yes it is a nsaid. I take it for my arthritis but it is really hard on the liver. I take the human form called meloxicam and know that when I have taken it a lot over the month my bloods show a dramatic increase on my liver tests.

Phoebe took it occasionally and Nelson too but Buddy was not allowed because of the diabetes and also the cushings factor.

I suppose it is like a lot of drugs that you find the exact dosage that will help without causing any more problems.

I though it was also a big harsh on the stomach so I don't know how Annie would go with it. Does she act like she is in pain or just depressed?

Jenny

[frijole]

Glynda - no he did not examine Annie's legs. While she was in his office she was running around like a pup. I told him it comes and goes and it came w/the urination (like a rush of cortisol production hit) in between the ldds and the acth tests. It went away with lysodren treatment as did the urination.

I think he threw it out there without thinking and being exhausted from my saying - So if you don't treat the cushings WTH would you do about the appetite and the legs? Thus the two drugs he threw out. I knew to check here before giving it to her.

Sue - her low water intake has just been since this past weekend. She never had anything greater than 1 1/2 cups a day and she is 14 - 15 lbs.

He thought based on the ultrasound that the bladder is not an issue. He is unfamiliar with the uc:cr test. I debated this with him a few weeks ago.

My plan was to do a full panel on her thyroid (Dodds) after her cushings was settled. He does some basic in house testing. For some reason he is not keen on sending things out. Yesterday when we were debating the pancreatitus testing he said the in house screenign is only $16 and I said "Doc I DO NOT CARE about the cost".

I am off to work - wishing all a great day. Thanks as always, Kim

[frijole]

Doc called to say that he check two enzymes for pancreatitus on yesterday's test and both came back negative. (Not Idexx test - an in house one)

[Harley PoMMom]

The snap cPL test, which is done in house, is to test the lipase levels. And the results would be normal or abnormal. Did he tell you specifically what pancreas test he did?

[frijole]

The snap cPL test, which is done in house, is to test the lipase levels. And the results would be normal or abnormal. Did he tell you specifically what pancreas test he did?

he doesn't have access to the snap test but this is his inhouse version of the same. it measures lipase and amalypse (sp?) if i wrote it down right.

[lulusmom]

I suspect that Kim is right and he only has the lipase and amylase values which is what you get on a standard blood chemistry.

[Harley PoMMom]

The lipase and amylase levels can be normal on the chemistry tests in a dog with pancreatitis as my Harley has proven that...his were, but his cPLI was 464 (0-200) at that time.

[lulusmom]

Kim, it seems that pancreatitis is becoming more and more prevalent on the forum so I've been doing a lot of reading about it. The one thing that stick in my mind is if you were to play a word association game with a knowledgable vet and you said pancreatitis, the vet would probably say "Miniature Schnauzer." They are the one breed that has shown up in just about every paper I read. I will echo Lori and tell you that just because the lipase and amylase are normal, doesn't mean that pancreatitis isn't brewing.

I could relate a lot of the stuff I've read lately but I ran across a terrific paper presented by IDEXX Laboratories called Diagnosing and Treating Pancreatitis, A Roundtable Discussion, which I heartily recommend that you read. They have a great paper on diagnosing liver disease as well. Even if Annie's problem isn't pancreatitis, you will have a much better understanding of the condition, which will come in handy for those times when Lori starts going off on the subject and you just sit there scratching your head. We've had so much exposure to pancreatitis lately that my head was getting raw from scratching it. I thought it wise to save the bit of hair I have left by continuing my education.

http://www.idexx.com/pubwebresources...roundtable.pdf

[frijole]

Wow Glynda, where do you find these articles? ha. I will print it at work tomorrow and read at lunch. I believe what you guys have told me...I am just tired and my brain is fried. I am no expert at pancreatitus but I have read enough posts here to know it is real and frequent, particularly in schnauzers. I'm just tired of arguing with and educating a vet.

Annie ate well today. She ate her chicken/rice in the a.m. like a cush dog. I left food out for the kid next door to place on the ground as a test. It was 1/2 of a normal helping of her kibble. Plain and nothing on it. I came home and it was all gone.

There was also pee in the living room. In all fairness - I didn't get home til 6:40 - more than an hour later than normal... her water intake today is less than 3/4 of a cup.

Anyway, I gave her a 3rd meal (more rice/chicken) and she inhaled it.

So - either that drug he prescribed (and the pepcid ac) worked wonders or her cortisol is rising...

Her last lysodren dose was on 5/29 in the a.m. So it has been 10 1/2 days.

[acushdogsmom]

he doesn't have access to the snap test but this is his inhouse version of the same. it measures lipase and amalypse (sp?) if i wrote it down right.

Okay, is it possible that your Vet doesn't know about the more accurate (and newer) way that many vets are now using to diagnose pancreatitis in dogs?

I gave you this link before, but here it is again ... maybe you can print it out for your Vet to see. It is written by Dr. Jörg M. Steiner from the Texas A&M Gastrointestinal Lab, one of the developers of the Spec cPL (also known as the Spec cPLI) test.

http://www.cvm.tamu.edu/gilab/resear...reatitis.shtml

Here are several quotes from that article:

Introduction:
Pancreatitis, an inflammatory condition of the exocrine pancreas, occurs frequently in both dogs and cats. While the true prevalence of pancreatitis in dogs and cats is unknown, recent studies would suggest that pancreatitis is a rather common and underdiagnosed condition in both dogs and cats. In a large retrospective study of necropsy findings 1.5% of 9,342 canine and 1.3% of 6,504 feline pancreata showed important pathological lesions. Pancreatitis can be difficult to diagnose. This may be due to the non-specific clinical signs commonly displayed by pancreatitis patients. However, there also has been a lack of diagnostic tests for pancreatitis that are both sensitive and specific for pancreatitis.

Clinical picture:
Clinical signs of dogs and cats with pancreatitis depend on the severity of the disease. Mild cases may remain subclinical while more severe cases may present with a wide variety of clinical signs. In a recent retrospective study of 70 dogs with fatal pancreatitis the following clinical signs were reported: anorexia in 91% of the cases, vomiting in 90%, weakness in 79%, abdominal pain in 58%, dehydration in 46%, and diarrhea in 33%. These findings are somewhat surprising as abdominal pain is the key clinical sign of pancreatitis in human patients. Thus, the question arises whether dogs with pancreatitis have abdominal pain less frequently than humans, or more likely, whether we fail to correctly identify abdominal pain.

It goes on to say:

Serum lipase activity:
Serum lipase activity has been used for the diagnosis of human and canine pancreatitis for several decades. However, it has long been recognized that serum lipase activity is neither very sensitive nor very specific for pancreatitis in either species.

In summary, serum lipase activity is neither very sensitive nor very specific for diagnosing pancreatitis in dogs

Serum amylase activity:
The diagnostic utility of serum amylase activity for canine and feline pancreatitis is very similar to that of serum lipase activity. Some dogs with spontaneous pancreatitis have an elevated serum amylase activity, but others have serum amylase activities in the normal range.

Pancreatic lipase immunoreactivity (PLI):
Recently, assays for measurement of pancreatic lipase immunoreactivity in dogs and cats (cPLI and fPLI, respectively) have been developed and validated. As mentioned previously, many different cell types in the body synthesize and secrete lipases. In contrast to catalytic assays for the measurement of lipase activity, use of immunoassays does allow for the specific measurement of lipase originated from the exocrine pancreas.

The sensitivity of serum TLI concentration was below 35% and that of serum lipase activity was less than 55%. In contrast, the sensitivity for serum cPLI concentration for pancreatitis was above 80%.
In another study of cats with spontaneous pancreatitis serum fPLI concentration was more sensitive and more specific than serum fTLI concentration or abdominal ultrasonography.

These initial data would suggest that serum PLI concentration is highly sensitive and specific for the diagnosis of pancreatitis in dogs and cats.

So the test that you need the vet to run, if you are trying to diagnose pancreatitis, is the Spec cPL test (also called Spec cPLI), not just serum amylase and lipase. Spec cPL is the current gold standard blood test for diagnosing canine (or feline) pancreatitis. To run a Spec cPL test, the vet used to have to send a fasted blood sample to the Texas A&M Lab to get a Spec cPL test run, but now, IDEXX Labs can run the Spec cPL test, too.

http://www.idexx.com/view/xhtml/en_u...s/spec-cpl.jsf

The Spec cPL® Test is a revolutionary test that allows you to quickly and confidently rule in or rule out pancreatitis in dogs.

Originally developed as the cPLI test by Dr. Jörg Steiner and Dr. David Williams in the Gastrointestinal Laboratory at Texas A&M University, the Spec cPL Test offers:

Unprecedented accuracy—With more than 95% specificity and sensitivity (as compared to the cPLI assay), this test far outperforms other test methodologies, so you can treat confidently.

Fast results—Tests are run daily so you can move ahead quickly with treatment.

The Vet just takes a blood sample from a dog who has been fasted and sends it out to an IDEXX Lab for analysis (requesting the Spec cPL test to be run). Your Vet can call any IDEXX Lab and ask about the Spec cPL test that can now be done to more accurately diagnose pancreatitis in dogs. They'll tell him (or her) that it is indeed the gold standard test to do now - much better than just measuring serum lipase and amylase.

P.S. There is also apparently a version of the cPL test that a Vet can do in-house with a so-called "Snap reader" apparatus, if they have it in their office, called a "Snap cPL". But as far as I know, it's not as good as running a Spec cPL that is sent out to IDEXX Labs to analyse.

http://www.idexx.com/view/xhtml/en_u...e/snap/cpl.jsf

It's all a bit confusing, I know, but I hope this long post makes some sense to you.