Severe Ibd On Top Of Sibo

[greyhead]

Thanks, Robin. I'm so glad Beau has done so well for his sake and yours. And it encourages me that Spencer will get through it too. But I confess I'm more than slightly nervous about getting the food and medicine choices right!

[greyhead]

Finally got a message from the vet at 4:00. (Didn't get to speak with her. We'll do that tomorrow, hopefully.) Expected to hear something last Monday, but she didn't hear back from the internist until today.

 

Short course: The internist doesn't think we have a diagnosis because IBD can only be truly diagnosed through biopsy. Given the location of Spencer's problems, it would have to be surgical. The vet knows, on the other hand, that we're reluctant to put him through that. The ultrasound showed thickening of the small intestinal wall and parts of the stomach lining, lymphangiectasia of the lymph structures and dilated lacteals. So all that surgical biopsy would add, if I understand this at all, is identification of the particular type(s) of inflammatory cell(s) involved. This might or might not lead to better (i.e., more focused) choice of medicine?

 

So our vet's message said that she's been reading and reading and reading to come up with a plan and that she has one. It doesn't include surgery. I don't know what it does include, but I'll find out tomorrow. I'm probably going to reject any prescription diet that relies heavily on carbs, as Spencer has not seemed to handle them at all for a long time. He's doing pretty well on raw venison which, since it doesn't contain bone, I can also cook if that seems like a better idea.

 

And I'm leaning toward the budesonide/Flagyl/single novel protein solution that tbhounds suggested. (Venison was novel to him as of a week ago, and I'd just as soon stick with it.) Spencer dropped 10 pounds fast when he was briefly on prednisone, and I'm not eager to repeat that if we don't have to.

 

Since he has been off Flagyl for a week, I'll take in poop tomorrow for retesting for his SIBO problems.

 

So I'll post more tomorrow after speaking with the vet. Anybody have any thoughts relative to the questions I've posed or anything else? Particularly whether surgical biopsy is required?

 

Thanks for all your help! I try to stay calm and clear for Spencer's sake, but JEEZ the waiting/worrying has been hard! Especially with Spencer being on no medicine whatsoever the last week.

[Batmom]

How is he feeling? (I can guess how you are feeling -- worried and frustrated!)

 

I would not be a fan of surgery unless it was going to make a significant difference in a treatment plan. Usually it doesn't but there are exceptions.

[greyhead]

How is he feeling? (I can guess how you are feeling -- worried and frustrated!)

 

I would not be a fan of surgery unless it was going to make a significant difference in a treatment plan. Usually it doesn't but there are exceptions.

Yup, that's how I feel! Spencer had been doing very well, I thought: dark brown poop, starting to get texture even without any bone in his diet for a week, enthusiasm for walks and stuffies. Then DH took both dogs on two walks on Sunday, each of about 2 miles! (He knows walks make Spencer happy, and he wanted to make him very happy before he left for a week in Texas!) Problem being that Spencer then lost a couple pounds, visibly! And he became less vigorous about everything, less sure-footed, etc. So I've spent all week trying to increase his food intake a little and give him short walks. He's responding well, but his poop is going back from brown to yellow/orange and softening. So I'm hoping that getting him back on Flagyl will straighten that out.

 

ETA: He has been less gassy and gurgly since he was switched from cooked chicken to raw venison. He would like to eat more than the 2 lbs a day I've been feeding him. If we can keep him on it, I've found I can get a better price on 5-lb buckets than on the 2-lb chubbs I've been getting.

 

Thanks for the vote on the surgery. I would have felt better about doing it if Spencer hadn't lost 2 lbs just from walking 4 miles! I guess the internist isn't going to help with the treatment plan if we're not going to do the biopsy. So it'll be up to the regular vet and us, with help from GTers, to fashion a treatment plan if we don't biopsy.

Edited April 30, 2009 by greyhead

[Guest zoolaine]

Hugs to sweet Spencer. I'll be watching for your post tomorrow.

[Guest mandm]

I'm also curious about what the vet recommends.

 

I'm "lucky," I guess, that both my presumed IBD greyhounds responded to IBD treatment. If they hadn't, I probably would have biopsied.

[Guest SoulsMom]

How is he feeling? (I can guess how you are feeling -- worried and frustrated!)

 

I would not be a fan of surgery unless it was going to make a significant difference in a treatment plan. Usually it doesn't but there are exceptions.

 

I agree. Thanks for the update! It sounds like you are headed in the right direction

 

When Soul has his unexplained GI bleeding my vet wanted to first do an ultrasound and if what he saw on that was inconclusive to do the scope. He really didn't want to open Soul up unless absolutely necessary, and it would have been a last resort.

Edited April 30, 2009 by SoulsMom

[greyhead]

Played phone tag with the vet today; I was at a mandatory event so loud that I couldn't even hear my cell ring!

 

But her message said her researches have led her to budesonide. Seems to her like people start with other things like pred but very often wind up at budesonide anyway. This is good because I'd reached the same conclusion! She didn't mention Flagyl, but I made an appointment for 8:30 tomorrow to discuss that with her; I think he is going to need it, but I'll take in a poop sample for another C&S to recheck the Clostridium. Two more are included in the fee, so I'm thinking Helicobacter, and I don't know what the third should be. They already ruled out Salmonella and E. coli last time.

 

Her message said the internist recommends a low-fat food, and perhaps something by Royal Canin in particular. He's been on low-to-no fat for months anyhow on his raw diet. I'll discuss kibble, but if it's not no-grain/low carb, I don't think we're going to do it. And we're definitely not doing poultry either, so that probably lets most prescription diets out. I'll cook the venison if that'll make everybody happy!

 

I've read Tigger's posts about Stevie's IBD treatment, especially from last Nov. 7. Their good vet recommended probiotics, glutamine, denamarin (SAMe & milk thistle) for liver support, and fish oil for Omega-3's, among other things. We've had complications with probiotics, but maybe keeping it simple, like with acidophilus, would be worth a try. Tigger, if you're reading this, I can't thank you enough for sharing Stevie's story.

 

So that's how it stands, and I'm tentatively optimistic. As always, I welcome your thoughts. I'll post again tomorrow after actually talking to the vet about the food and Flagyl.

 

Many thanks for your support. It sustains me and, therefore, Spencer.

 

ETA: Vet's message said internist still wants to biopsy but, since I'm not going there now, she's consulting with my vet anyhow, I guess.

Edited April 30, 2009 by greyhead

[greyhead]

The internist is off the team. Her choice. No biopsy = no IBD diagnosis on her planet. So she won't play. (I understand most specialists would agree with her.) She wanted to do endoscopy if not surgery, but endoscopy can't get to the parts of the small intestine that the ultrasound demonstrated, structurally, to be problems. Well, it could get to the jejunum, but that's all.

 

So the vet did put him back on Flagyl after we talked today, dosage reduced from 2000 mg/day to 1,000. Another C&S will show the bacterial status of things, so that'll be good. He starts budesonide, 2mg/day, on Monday when it gets here. And she's fine with sticking to raw venison. I don't know if she's that big a fan of raw, but he's doing well enough that she doesn't want to change anything beyond the meds at this point. (We may add Forti-Flora soon.) While venison isn't cheap, and DH and I have been getting by on tortillas and cheese , we did just get our tax refund, so for now it's all good.

 

Vet said she had been guardedly optimistic. But now that she has read more stories of successful IBD treatment, she's "a step closer to plain optimistic." I love our vet! (She did say she'd read that budesonide may have two downsides: shedding and "goofy behavior."

 

Thanks everybody for the PM's and posts, the support, and answering my endless questions. Spencer's a gentleman hound and would be mortified if I didn't express his gratitude as well.

[Guest SoulsMom]

I hear ya about surviving on tortillas and cheese! (good to know I'm not the only one) That and 99 cent noodle bowls from Trader Joes

 

Did you talk fiber at all? Soul's problems are suspected to be dietary and one vet suggested adding metamucil to his meals.

Edited May 1, 2009 by SoulsMom

[RobinM]

The internist feels that way because the only way to get a conlusive diagnosis of IBD is to do a biopsy.

 

I hope he repsonds to the meds.

 

ETA- there is an incredibly insightful and extremely helpful IBD board on yahoo. It's called IBD dogs.

 

They know more than the vets, it's amamzing. It is a heavily moderated board and I am not sure if there rules have changed but you can try. When I joined you had to have a diagnosis by bx, or you could not join.

Edited May 1, 2009 by RobinM

[greyhead]

I hear ya about surviving on tortillas and cheese! (good to know I'm not the only one) That and 99 cent noodle bowls from Trader Joes

 

Did you talk fiber at all? Soul's problems are suspected to be dietary and one vet suggested adding metamucil to his meals.

We did talk about fiber at my urging. I was wondering if I should add beet pulp at least to his food. But the vet doesn't want to mess with that right now and is just saying give him calcium citrate in the absence of bones/necks. Since we're adding budesonide, she wants to watch his reaction to that and be able to surmise that any reaction he has is to that and not some other change. But I'm sure we'll get back to the fiber issue in a couple of weeks!

 

Just got back from Costco where, emboldened by our tax refund, I bought steak for a change! But it's just a temporary treat! Fortunately, we like tortillas and cheese!

[tbhounds]

Glad your starting the Budesonide---really was the only medication that helped my boy--Pred did zero for him. He was started on 3mgs a day and eventually he became so stable we were able to reduce the frequency to once every third day.

The nice thing about the Budes. was there were NO side effects that I noticed. No increase in drinking and urinating-no shedding and no "goofy behavior"

[greyhead]

The internist feels that way because the only way to get a conlusive diagnosis of IBD is to do a biopsy.

The vet and I both get that. But we feel that what may be ideal for getting an ironclad diagnosis is not best for Spencer and that the evidence we already have is far, far more than merely suggestive. In any case, there are other specialists if we need them and perhaps one of them is a bit less rigid.

 

I hope he repsonds to the meds.

Thank you! We're hopeful. I feel really good about starting with budesonide.

 

ETA- there is an incredibly insightful and extremely helpful IBD board on yahoo. It's called IBD dogs.

 

They know more than the vets, it's amamzing. It is a heavily moderated board and I am not sure if there rules have changed but you can try. When I joined you had to have a diagnosis by bx, or you could not join.

Yes, I can imagine that every dog with diarrhea could wind up being a topic of conversation if they didn't have some narrowing principle. I'll see if I'm permitted to read the posts even if I can't join. Thanks for the suggestion!

 

Beau still doing great, I take it. Gained all his weight back. That's so cool!

[Guest SoulsMom]

I hear ya about surviving on tortillas and cheese! (good to know I'm not the only one) That and 99 cent noodle bowls from Trader Joes

 

Did you talk fiber at all? Soul's problems are suspected to be dietary and one vet suggested adding metamucil to his meals.

We did talk about fiber at my urging. I was wondering if I should add beet pulp at least to his food. But the vet doesn't want to mess with that right now and is just saying give him calcium citrate in the absence of bones/necks. Since we're adding budesonide, she wants to watch his reaction to that and be able to surmise that any reaction he has is to that and not some other change. But I'm sure we'll get back to the fiber issue in a couple of weeks!

 

Just got back from Costco where, emboldened by our tax refund, I bought steak for a change! But it's just a temporary treat! Fortunately, we like tortillas and cheese!

 

I understand that! With Soul I've been taking things very slow, only one change at a time, and even keeping a diary of his day. So much fun to describe on paper every night the consistency of his poop or how many times he farted and if they were stinky

[Guest houndlover]

I am so glad that there is a "plan of attack" in place for Spencer. I would not be in favor of any type of invasive procedure for my pet either so I would have done the same as you. It is great that you have a vet that you like and can depend on. Fingers crossed that Spencer will continue improving when he starts on his new treatment plan.

[Guest mandm]

http://query.nytimes.com/mem/archive-free/...9679D94649ED7CF

[greyhead]

http://query.nytimes.com/mem/archive-free/...9679D94649ED7CF

Yeah, Wendy, that sounds right up my alley! I'm impressed with your research skills!