Should We Get Endoscopy/biopsy For Diagnosis?

[greyhead]

Hi everybody ~

 

Spencer's doing much better! Thanks so much for asking. He's like a different dog!

 

We opted to skip endoscopy or surgical biopsy for now, with the vet's blessing, since the treatment of whatever caused his GI distress would be substantially the same no matter what.

 

Starting last Friday he's on Flagyl and prednisone for three weeks, followed by reassessment. I gave him his second B12 (cobalamin) injection yesterday, and he'll get those weekly for six weeks, then bi-monthly for a few months, then monthly for life. It hasn't been explained to me yet why "for life," but I'll find out next time we speak. I assume that the pattern of B12 and folate deficiency shows a degree of GI tract damage such that the ability to manufacture B12 with abdominal or intestinal bacteria, or to absorb them orally, is permanently impaired. But at some point these B12 and folate levels will be reevaluated also. All these tests, by the way, were sent by our local Phoenix Laboratories to the veterinary GI lab at Texas A&M for evaluation. They actually do canine (and maybe feline) GI research there and are a great resource for pups with these kinds of problems.

 

Meanwhile, Spencer's appetite has improved dramatically, as has his demeanor. His eyes are no longer sunken, he's perkier and more energetic, and he no longer makes growly noises to protect his food/treats from his brother Shane. Oh yeah, and he's not trying to eat poop anymore. Interestingly, he doesn't need to go out in the middle of the night now either -- a huge relief for me! I was never sure exactly what he was doing out there, but you don't tell a dog with diarrhea to just go back to sleep! (I suspected he was poop hunting, but the yard's a little too big and there are

enough shrubs and trees to block the view that unless I got dressed and went out with him, I couldn't know for sure.)

 

The vet wanted to hold his diet constant for now, since he was eating what he was being served even though his eating was erratic. That makes for fewer complications in evaluating his response to the medicines. After that's done, we'll see how he's eatingand decide if there's a better approach, at least in terms of optimizing the health of his GI tract. It wasn't food that caused this, but food may have a role to play in its management.

 

I'll post again if anything new or interesting develops. Meanwhile, I'll just say that whatever else folks do for pups with GI issues, testing for malabsorption of food/nutrients via cobalamin and folate, and giving cobalamin if needed, seems to be a VERY GOOD IDEA! I see immediate improvement each time he gets a shot. When I have a minute, I'll try to post some links to information on how cobalamin works in this whole process. There's a very good link on it posted earlier in this thread by ahicks too. And I really like the article my vet gave me, but she got it online through the VIN (vet info network?), and I can't access it. I'll see if she can email me a copy as an attachment that I can then either post or send to people who request it. Or can any of you help me with that faster?

 

If anyone has any any questions for me or for me to ask my vet, do speak up! And, as always, thanks SO much for your help!!!

Edited January 27, 2009 by greyhead

[ahicks51]

Interestingly, "fecal transplants" have been employed in the management of various intestinal disorders. Makes one wonder what the value would be for a canine that has had such a set of symptoms; after all, folate and B12 are both produced by bacteria in the gut.

 

WARNING: GETS SERIOUSLY GROSS FROM HERE. GO READ SOMETHING ELSE, LIKE BOINGBOING.NET.

 

The "do it yourself" version- an indication of both how screwed up our healthcare system has become as well as the levels of desperation that some folks come to with their own guts- involves a healthy donor, an enema bottle, some mixing, and a strong stomach. Indeed, the coprophagia is interesting in itself as it implies (dime store microbiologist speaking here) the dog could unwittingly be trying to re-inoculate its own digestive system.

 

Either that, or they just like to eat poop.

 

Anyway- if you don't care to be giving injections, the B12 patch might be worth pursuing.

 

http://www.b12patch.com/

[Guest zoolaine]

Glad to hear Spencer is doing better.

[greyhead]

Interestingly, "fecal transplants" have been employed in the management of various intestinal disorders. Makes one wonder what the value would be for a canine that has had such a set of symptoms; after all, folate and B12 are both produced by bacteria in the gut.

...

Indeed, the coprophagia is interesting in itself as it implies (dime store microbiologist speaking here) the dog could unwittingly be trying to re-inoculate its own digestive system.

Wow, that is REALLY interesting!

 

Anyway- if you don't care to be giving injections, the B12 patch might be worth pursuing.

After giving sub-q Lactated Ringers (pre-warmed) for years to two uncooperative cats with CRF, and injecting B12 into the line at the end of each session, giving a well-behaved greyhound a quick B12 shot is a walk in the park...with sunshine, balloons, and a taco cart! But thanks for the good thought!

[Guest Spencers_Greyt]

I'm glad Spencer is doing so much better!!

[Guest mandm]

That's great news! Please keep us updated.

 

I would be very interested in articles you mentioned.

[greyhead]

Okay, update time! The bad news: Spencer lost 3 lbs. in 12 days, as measured 2/4 at the vets. Eyes looking sunken again, of course, and even bonier than before, at 78 lbs (down from 89). But he had been eating rather well since the B-12, metro and pred.

 

So in a last-ditch attempt to avoid biopsying, I asked the vet if we could try raw. Some people spoke of that in PM's as having been THE thing that turned their dogs situations around. The vet recommended a local company that produces prepared raw food, and I picked some up that afternoon.

 

GOOD NEWS: Had no trouble at all getting Spencer to eat it! Over the next couple of days his poops got firmer, forming piles rather than splats. And as of late Friday, we have logs more than half the time!!! (Oh, the vocabulary we're developing. DH wonders if this is like Eskimos having a bazillion words for "snow.") And the color is slowly improving, I think, but not as much as we'd like. This is not going to be a fast process, I know.

 

The vet agreed that his pred dose was low, half the lowest recommended for his size, as some blessed GTer had suggested. So she doubled it, to 20 mg 2x/day. His side effects don't look any worse than before, although his liver values are up. By the blood work we had done on 2/4 his ALP is 149 (10-84) and ALT is 129 (5-65). Since that was on the lower pred dose, I'm a tad nervous about what they'll be now! He's still on the same dose of metro and cobalamin. His cholesterol is low -- 89 (150-275) -- which is probably due to malabsorption. Some other values are only very slightly out of range.

 

Spencer's case file is going to an internist who specializes in GI problems. We'll get on her calendar for a consult. Maybe if this new regimen keeps producing improvement, we won't have to biopsy. I am one of those people who likes to know what she's dealing with, but not so much in this situation, not yet anyway. I mentioned raw to RobinM regarding her Beau, and she tells me that raw food would just make an IBD dog worse. So maybe in this feeding experiment we're ruling out IBD as the source of the malabsorption.

 

Thank you, all of you, so much for your help and support. I find myself now worrying more about Beau than about Spencer! But in truth I'm still worried about Spencer. I can't imagine how he's going to put the pounds back on. As always, your thoughts and good wishes will be appreciated.

FOR YOU:

 

 

 

 

[greyhead]

That's great news! Please keep us updated.

 

I would be very interested in articles you mentioned.

My vet tried to email me the link to the Vet Info Network article on cobalamin so I could post it on GT for those who've expressed an interest. But the link doesn't work unless you're subscribed. I can try scanning it and emailing it to anyone who's interested, or I can just mail you a hard copy. Below are some other links that can be accessed.

 

http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml

http://www.cvm.tamu.edu/gilab/assays/b12folate.shtml

 

http://74.125.95.132/search?q=cache:7x-6Id...cd=14&gl=us

 

 

[Batmom]

Raw won't necessarily make an IBD dog worse. It often has the advantage of having fewer ingredients and more easily digested ones, vis a vis kibble. On the down side, it is more likely than cooked food to carry a bacterial load that can make a dog ill.

 

Fingers crossed that your pupper does well and makes a good recovery from his troubles.

[dmswartzfager]

I also disagree with raw making an IBD dog worse - Blitz was diagnosed with moderate IBD via biopsy about a year and a half ago (when we adopted him), and he's doing wonderfully on the raw diet. Via the raw diet, we were able to figure out he's allergic to beef, but poultry is okay, as is venison.

Edited February 8, 2009 by dmswartzfager

[Guest mandm]

Thanks for the update -- I'm glad it's a good one.

 

I would also think that the improvement resulting from raw is unfortunately not a rule-out for IBD. However, IBD is not so bad at all if can be well controlled by diet.