Kelly Dilemma

[Guest Stripeyfan]

I think I have already made my mind up about this, but guess I need reassurance that it’s not a stupid decision.

 

Kelly finished his 2nd 3-wk course of ABs on Weds and yesterday the diarrhea came back. Luckily, this time I’d asked the vet to have some of his tablets (oxytetracycline) on hand, so he’s back on them. It wasn’t bad D but we starved him too to help settle things down and I’m hoping today we’ll know if it’s worked.

 

My dilemma is this. From the start our new vet has talked about having Kelly scoped and biopsied if he didn’t improve to determine exactly what’s going on inside him, but had always talked about it being wayyyy in the future. Tests have shown malabsorption in the small intestine and we think he has some form of IBD, either caused or made worse by a massive roundworm burden. There’s a chance it could be something more sinister BUT he’s very young (only 4), has been eating well throughout and over the last 6 weeks has made huge improvements on ABs and a low-ish dose of pred (an anti-inflammatory dose rather than an imunosuppressive dose).

 

But because he can only eat a home-cooked bland diet (any commercial food seems to cause problems), and because every time we’ve finished the ABs, and when, a couple of weeks ago, we tried to lower the pred dose from 10mg/day to 5mg, his stools get/got yucky again, the vet is being more insistent about the operation – even though, on our last visit this week for a check up, she did say she was happy for him to remain on the pred for a while longer as long as we understood the risk of side effects, and that he may need ABs for life which she doesn’t have a problem with anyway. She also said we should keep him on his bland diet for at least another 2 months before trying any different food. All this gave me the impression she was happy to carry on as we were – until the scary conversation DH had with her yesterday after we rang to tell her we’d had to start the ABs again.

 

Ourselves, we do NOT want to go down this road yet. Kelly has only been receiving treatment for 6 weeks, after 3 months of our old vet doing nothing much at-all except aggravating things. Before that (before we got him) he’d not been wormed for months and months. Our vet that we have now also thinks it’s possible that at some time before he came to us he might have had a horrible GI virus that weakened his system and is the reason he has no parasite resistance (we are now on a monthly worming protocol so that he doesn’t pick the roundworm up again from our yard).

 

It’s not the cost (although that is SCARY) – if he needed surgery that cost what this would to cure an acute condition like a broken leg or to remove a tumour, we’d do it in a heartbeat. But this won’t cure him. As far as I understand it, if it is IBD, all it will do is tell the vet what sort of inflammation/damage is causing it – he’ll probably still need to be on all the meds he’s on, plus have major surgery to recover from – and that’s if he makes it through in the 1st place. If he has something worse, like intestinal cancer, the op won’t solve anything either, and instead of being able to make him comfortable for as long as possible, we’ll have given him something else to try and fight against or maybe even ended his life quicker.

 

Surely there are other options we can explore first. If he wasn’t responding to the meds it would be different, but he is. And he has only been on 1 sort of AB and the pred so far. We haven’t even done a stool test to see if the D he gets when he comes off his ABs is being caused by SIBO – I am talking to the vet on Tuesday and hopefully we will get that done then, once we’ve decided which bacteria to test for (I’m thinking whatever the ‘usual suspects’ are plus clostridium). I can understand why the vet wants to know exactly what’s going on, but I’m trying to think about his quality of life here.

 

And maybe he just needs more time – giving him only 6 weeks to heal doesn’t seem very long to me, especially considering he’d lost close to 20 pounds and was in a terrible state. Right now, adding to the scarring and damage in his intestines just seems like a really, really bad idea to me. Yes, the meds could have effects later on, especially because he's young... but the surgery could kill him sooner. We know his GI tract is abnormal just from what has been coming out the other end, and I don’t think he will ever be a truly healthy dog – he may not even live as long as he should because of this – but if we can manage his condition and give him a good life without putting him through what I think right now is uneccessary trauma then surely that is a better thing to do?

 

Thanks for taking the time to read this!

[ahicks51]

Is budesonide a drug that is available for veterinary use there in the UK? If so, has this option been discussed?

[JohnF]

I can understand your worry. This 'scoping and biopsy' though, isn't it going to just mean samples taken during a colonoscopy or endoscopy as in human medicine?

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2586&Category=414

Your only worry there, unless there is serious bad luck with any varicose structures (10,000:1)is going to be the anaesthetic and as it would be a quick procedure it needn't be that deep? Just ensure your vet knows enough about greyhound doses - get a print out and hand it to them, pointing out what is recommended for greyhounds.

Isn't it true that you can only really decide how to deal with something once you actually know what you're dealing with? If the exams show nothing, if the metabolic tests show nothing, then you can rest assured that you are dealing with IBS or some other idiopathic condition that's likely to be unique to your dog.

Also, long term antibiotics are killing off the intestinal flora and making it just like you're changing your poor dog's diet completely every day! You could at the very least add a little probiotic natural yoghurt to the food to try and put this right in between doses.

I suppose you've already tried a home cooked chicken and rice diet, or gone back to basics with something less rich like Couuntry Valu sensitive greyhound food?

Please feel free to email me if it may help.

[Batmom]

FWIW, I agree with you. You've got a regimen that's working well for the dog (and since it is working, I'd keep him on it straight, no breaks, for at least 3 months). Unless there's a good chance that biopsy results would radically change your course of treatment, it seems a needless expense for you and a needless risk for your dog.

 

I wouldn't bother with probiotics *while* you're giving antibiotics unless you've got some indication that the antibiotics you're giving do not affect the species in the probiotics. I've never looked into whether they do or don't so YMMV there.

[Guest SusanP]

We have been going through something similar with our Wizard, though in his case, the vet isn't even positive it's IBD. The specialist we saw understood our reasons for not wanting to put him through a surgical procedure, and we went ahead and treated for IBD with the understanding that if it was actually cancer (unlikely in light of his history with this), he would get better briefly and then worse within a few months. So some vets will work around surgical biopsy.

 

In Wizard's case, it appears the prednisone made him very sick, though it did help the original symptoms. We are now tapering off of it and he seems to be improving very quickly.

 

I guess you could discuss again with your vet your reasons for not wanting to do surgery and see where s/he is willing to go, given that. I know how distressing this is, having just gone through it myself.

[Guest Stripeyfan]

Thanks for the replies so far and thanks, JohnF, for the link. The impression I’ve got, though, from previous conversations with our vet, is that the procedure Kelly would need is very invasive because the main problem is with his small intestine, which is hard to get to.

 

He has only been on treatment for 6 weeks. For the 1st 2 of those weeks he actually got worse – carried on losing weight etc. Then he plateaued, and for the last 3 weeks has improved. So really, you could say he’s only just starting to heal. Of course if he NEEDS this operation, in the future, because nothing else is working, we’ll have it done. I just feel it’s a ridiculously drastic step to take right now. I’d rather explore other options first – and there MUST be other options, at this stage, than this. Mustn't there?

 

Argh.

 

ETA Batmom, our vet has already said that the biopsy etc might not change anything meds-wise (it certainly wouldn't if we did it now, I don't think)! Which also makes me think why bother. But I'd hate to think that we weren't doing the best for our boy.

Edited May 1, 2010 by Stripeyfan

[JohnF]

It may be helpful to take onboard that antibiotics work on the 'surface' bacteria and don't do so well at getting into and under the biofilms themselves. Therefore some probiotic intervention may actually be beneficial. Please see the link. (I'm not a vet, just hons. Zoology).

 

http://www.sciencedaily.com/releases/2008/12/081217190443.htm

Edited May 1, 2010 by JohnF

[Remolacha]

I understand (and agree with) your wanting to wait and give his current treatment a chance to really work. This vet has done a wonderful job with Kelly, maybe ask and see why she wants to do the surgery now?

 

I had similar problems with Fletcher when I first got him, and my vet said, let's treat this AS IF it were IBD and see what happens before we scope. That was when he was 2, he just turned 8, and never has been scoped. Most of the time, his conditioned is controlled with diet. Good luck with Kelly!

[greyhead]

I think I've already told you Spencer's story. A couple points relevant to your question:

 

Based on our experience, I'd be real uncomfortable cutting into a dog to do a biopsy when there was the possibility of thereby liberating SIBO germs to do even more widespread damage. So I'd insist on the poop culture and sensitivity test. If the vet didn't see the point, I'd say, "Humor me." But that's me.

 

As you know, Spencer had also lost 20 lbs. Not only would there be anesthesia, but also there was the post-op period of several more tough weeks to look forward to -- for the dog and for me! (JohnF, you'll learn more about this if you look up RobinM's threads on her Beau, who had the surgical biopsy. More than a year old, so you'll have to use "Beau" as a search term in the H&M forum and aim for 2008-2009. Beau is still with us, fortunately, but it was quite a haul.)

 

Mainly I wanted to add that Spencer saw his internist two weeks ago, after a year of treatment with budesonide (along with the usual a/b's). He had regained 13 of his lost pounds and she thinks he's doing well enough to start tapering off the budesonide. But only because I was curious, I asked if people ever wait until their dogs have recovered to the extent Spencer has and *then* do the biopsy (understanding that severe IBD is not something one usually ever cures, per se). She said yes, some do.

 

So there's always the option of letting Kelly continue to recover & gain weight on the program he is on. You can always do the biopsy later when he's in better shape. Maybe that thought will make your vet feel better, and he/she will leave you alone!

 

You have to do what you feel/think is right. We've had great success listening to our guts. Nobody but *nobody* knows better than you do how Kelly is doing and what he can take or should have to take.

 

(Personally, I didn't think the biopsy would necessarily end Spencer. But I couldn't justify putting him through it when it wasn't likely to affect his treatment, just because it's the textbook response to suspected IBD.)

Edited May 2, 2010 by greyhead

[Guest LindsaySF]

If the biopsy would not necessarily change the treatment, I would wait. Good luck.

[Guest Stripeyfan]

I think I've already told you Spencer's story. A couple points relevant to your question:

 

Based on our experience, I'd be real uncomfortable cutting into a dog to do a biopsy when there was the possibility of thereby liberating SIBO germs to do even more widespread damage. So I'd insist on the poop culture and sensitivity test. If the vet didn't see the point, I'd say, "Humor me." But that's me.

 

As you know, Spencer had also lost 20 lbs. Not only would there be anesthesia, but also there was the post-op period of several more tough weeks to look forward to -- for the dog and for me! (JohnF, you'll learn more about this if you look up RobinM's threads on her Beau, who had the surgical biopsy. More than a year old, so you'll have to use "Beau" as a search term in the H&M forum and aim for 2008-2009. Beau is still with us, fortunately, but it was quite a haul.)

 

Mainly I wanted to add that Spencer saw his internist two weeks ago, after a year of treatment with budesonide (along with the usual a/b's). He had regained 13 of his lost pounds and she thinks he's doing well enough to start tapering off the budesonide. But only because I was curious, I asked if people ever wait until their dogs have recovered to the extent Spencer has and *then* do the biopsy (understanding that severe IBD is not something one usually ever cures, per se). She said yes, some do.

 

So there's always the option of letting Kelly continue to recover gain wait on the program he is on. You can always do the biopsy later when he's in better shape. Maybe that thought will make your vet feel better, and he/she will leave you alone!

 

You have to do what you feel/think is right. We've had great success listening to our guts. Nobody but *nobody* knows better than you do how Kelly is doing and what he can take or should have to take.

 

(Personally, I didn't think the biopsy would necessarily end Spencer. But I couldn't justify putting him through it when it wasn't likely to affect his treatment, just because it's the textbook response to suspected IBD.)

 

Thanks for this, Greyhead (and to everyone else for their replies too). I have read the threads on Beau (so glad he's feeling better now!) and that is the type of surgery our vet is talking about - so, very invasive. If Kelly had not improved at-all on the meds I guess I would feel differently, but because he has I'm extremely reluctant to put him through anything like that when he's barely begun on the road to healing/recovery. I have nothing against this procedure and know how useful it can be, but at the moment, for Kelly, I think it needs to be a last resort.

 

I want to ask the vet if – unless he gets bad again, in which case of course we'd act immediately and do whatever we had to do – we can have more time, not days or weeks but months to allow him time to heal. And I want to ask if we can keep his meds the same. Instead of tapering off the pred again in a couple of weeks I'd like to leave it where it is, then taper off more slowly (maybe a mg at a time instead of just halving the dose) in a while – but not yet. I think his body simply isn't ready to 'go it alone' yet because of the months and months of this problem being left to build up by our old vet. Our vet now has already said she doesn't see a few more months on the pred being a problem so I hope she will agree to this.

 

I'm also looking into supplements such as glutamine and slippery elm, as I understand these promote gut healing. And should I ask if we need to think about B12 supplements, as the main problem seems to be malabsorption in the small intestine (probably due to all the inflammation/worm damage etc)?

 

I will keep everyone posted as to what the vet says. Thanks again to all of you for the advice, I really appreciate it.

[Guest kydie]

I have a GSP with IBD, all his life, and i agree with BatMom, although I did have him scoped and biopsies sent to Texas A&M 6 years ago in St College Pa. total with labs, meds, and preceedures was $845.00, was it worth it, YES he was 1 year old and we knew what we were batteling, but it still took months, and months, and months to get it under control, to find just what he could and could not eat, home made treats, and God help us if anyone gives him anything I don't approve of, or should I say God help them, this is a life long battle to keep him healthy, but worth the effort Good Luck I love him, he is my lamb, and worth every effort

[ahicks51]

I'm also looking into supplements such as glutamine and slippery elm, as I understand these promote gut healing. And should I ask if we need to think about B12 supplements, as the main problem seems to be malabsorption in the small intestine (probably due to all the inflammation/worm damage etc)?

 

Also note that from a nutritional standpoint, fats and proteins (minus allergenic components) seem to be safer in IBD. One human dietary component is coconut oil, up to 3 tablespoons/day may be well-tolerated; it's emulsified by pancreatic juices, and absorbed high in the small intestine, before it gets to areas that tend to be more affected in the large intestine. Ditto with other fats, but with conventionally-fed dogs, the risk of pancreatitis is real; Stefansson and others report feeding large amounts of fat to their dogs while in the Arctic, so- from a tolerance perspective- it's been done before.

 

I would suggest adding supplements one at a time; if a single product were to have adverse effects, you would be unable to determine which one it was. Glutamine is almost certainly safe, provided there are no other components mixed in there.

[greyhead]

As I understand it, if Kelly has Intestinal Malabsorption, he needs B-12 injections. B-12 is processed in the gut. In the IM condition, it no longer can be. That is why getting the B-12 orally or through food won't work. The injection is an easy just-under-the-skin that you can easily do at home. The dosage is 1cc per administration, and the needle is very thin (25 gauge) and slides in almost unnoticeably. The B-12 itself stings a bit; but that's nothing to a stoic greyhound!

 

We found that Spencer improved immediately once started on B-12. It's not a cure for anything, but it powerfully affects their functioning in just about every way.

 

Another aspect: You want to get this vitamin-deficiency variable off the table (by correcting it). Then you'll be much better able to see how the other treatments, like the prednisone, are working.

 

ETA: Eeesh, did I really write "gain wait" in my last post? Perhaps I shouldn't be posting after midnight.

Edited May 2, 2010 by greyhead

[Guest Stripeyfan]

B-12 is one of the things I am going to ask about – at least about having his levels re-tested at some point even if the vet doesn't think he needs shots.

 

Thanks so much for all the info and support, it makes me feel like this is not a selfish or stupid decision. (I spoke to some trusted relatives about it too last night and their opinion is exactly the same!)

 

Just a thought, but if Kelly was on ABs for 3 weeks, then stopped them and went back to square 1 with the D, then started the ABs again, in reality he's had 2 separate 3-week courses, not one 6-week one, hasn't he? Which might be why they didn't work again?

 

Just wondering...

[Guest kydie]

We did B12 injections twice a month for 6 months, levels checked, then every month, then levels checked, and now every other month, unless we have a bad bout Good luck keep us posted