Biopsy.....out Of Options And Hesitant

[IAMs]

Hey everyone,
Joel and I have been stalling, we've reached a point where a biopsy has been recommended for Maya and neither of us want to do that to our little girl. Below is just a synopsis of what her condition is and what we've tried so far. I guess we're just looking to hear from folks that have gone through the same thing and how the recovery was. I think we'll do it soon so she can heal while it's still too hot outside and be all set for camping season once it cools down.

Previous posts on this topic can be found here http://forum.greytalk.com/index.php/topic/299770-good-poop-bad-poop-what-on-earth-was-that-poop/, here http://forum.greytalk.com/index.php/topic/299927-food-changes-have-begun/, and here http://forum.greytalk.com/index.php/topic/300775-update-on-mayas-stool-issues/.


Maya's Condition: Maya has always had soft stool. When we adopted her in 2004 (18 mo) we found that Science Diet Sensitive Stomach yielded the best results (not great but acceptable) out of many other brands. Probably within the last 6 mo her stool has become worse. Usually the first poo of the day is the best with any additional poos being the consistency of chocolate milk. She is now just over 10 yrs and is quite lethargic, developing arthritis, has a dull coat, and is very skinny. We believe she is not getting the nutrition she needs out of her food and are assuming this is the cause for the previously listed conditions minus the arthritis.

Steps taken so far:
1) Stool: tested for parasites and came back negative
2) Diet: We tried to change her diet and tried all of the vet options (about 5 different types) and also the Iams green bag because so many on here have had luck. None of these options yielded firmer poop.
3) Ultrasound: An ultrasound was performed and a portion of the small intestine was observed to be inflamed.
4) Urine Test: Histoplasmosis is common in this area so we tested for it as that was an easy/non-invasive test to perform. Results were negative.

What's Next?:
5) Biopsy: This is the next recommended step in an attempt to diagnose the cause of the inflamed small intestine. The portion that is inflamed lies smack dab in the middle of the digestive system and a biopsy is recommended to access this area over other methods. We are stalling. This test is going to cause her a lot of pain. Maya has a low tolerance for pain and I fear a long road to recovery from the incision.

 

Thanks for listening..........

leigh

[rascalsmom]

What is her bloodwork like? Jack always had soft stool, and when we discovered he was losing weight we did a blood panel and found his protein was very low....did your dog have bloodwork done? Jack was losing protein, and ended up that he had lymphangiectasia.

[Guest Doggone]

I have only good wishes to give you and Maya.

[inugrey]

Have you tried treatment as if it is IBD? I recently went through this with one of my old girls. Based on input from this board I talked to the vet about treatment options and with adding the drugs she has cleared up. If she responds to treatment then why go through the pain of biopsy.

 

My girl's story is on this page just a few topics down.

 

http://forum.greytalk.com/index.php/topic/300370-managing-ibs/

[kikibean]

What is the biopsy going to tell you? Is it going to be something that they can fix?

 

I'm not really a big fan of doing a bunch of tests that will stress out / cause pain to a dog, particularly a senior, unless the results will determine a treatment option.

 

If doing it is only going to tell you for sure what it is, then I probably wouldn't do it. If it's because think they will find something they can fix, then I'd probably do it.

 

If the biopsy determines the cause, what will they do for treatment? Is it something they can do without the biopsy?

 

If the only point of the biopsy is knowing for the sake of knowing and not for a "fix", well then I most likely wouldn't put her through it.

 

Maddy recently had some inflamation in her intestine that caused her stop eating. We treated her with fluids, meds and then I switched her to Go Dog Salmon. So far so good.

[Batmom]

Assuming she basically feels well,

 

I see now that she does not feel well. Is there anything at all unusual in her bloodwork?

 

Assuming normal bloodwork, before I did a biopsy, I'd do:

 

- 10 days of Tylan

 

If that didn't clear things up:

 

- 3 weeks of novel cooked protein diet. Feed the protein only, NOTHING else except heartworm meds -- no supplements, no yogurt, no extra treats, no vitamin pills, no 2nd ingredient.

 

If that didn't help:

 

- Pretend she has IBD and treat with prednisone or alternative steroid.

Edited September 5, 2013 by Batmom

[claudiav]

I just went thru this with my new senior. I adopted him 6 weeks ago. He had healthy poops for 4 days, then out of nowhere, he started explosive, uncontrolled diarrhea. He became severely dehydrated and had to be hospitalized for 2 days, to get rehydrated, tested and treated. he was sent home with Flagyll and I/D prescription food. With treatment, he was able to control when he pooped, but it never actually improved in consistency. The smell is deadly. full blood panel and fecal culture showed that he did not have worms, but as a result of the severe dehydration, he was unable to absorb nutrients from his food. his racing weight was 78 lbs, back in 2006. He was down to 70 over the 7 ys he was retired in his prior home. Dropped to 63 at the time he was hospitalized, just 10 days after I adopted him. Appetite is great but severely skinny and loss of muscle mass. Brought back to my grey expert vet when there was no improvement, other than slight weight gain. She didn't know what else it could be and suggested a biopsy. I absolutely refused to put him thru that.

 

Luckily, I am part of a large greyhound walking group and one of the women had a similar issue with her grey, years back, when she adopted her. She recommended I get a second opinion from her vet who is an expert in stomach/intestine problems. I went Saturday for that second opinion, and although it cost me $850 in labwork, I am so greytful I did! She tested for all kinds of things that my grey savvy vet didn't think of. And just today we got the results we were looking for, got an actual diagnosis and treatment has already begun. She took blood, urine, and fecal, and tested for everything else they don't normally check for. GI panel test for maldigestion vs. malabsorption. Fecal panel test for infections (not parasite and giardia which had been tested and came back negative already). Cortisol test which screens for Addison's disease. These were all things my grey savvy vet never thought to check for. Thank dog he doesn't have Addison's, but he does have an infection in the intestinal tract caused by CAMPYLOBACTER. This specific bacteria can be very damaging to the intestinal tract, causing severe inflammation, and stops the body from absorbing nutrients and most importantly, B-12. He had a B-12 shot Saturday, as vet suspected this was going on, and he started feeling better that nite. He will have to get a B-12 shot once a week for a month, and once a month for the rest of his life. This specific bacteria is also resistant to most antibiotics, like Flagyll. He was on low dose Prednisone for inflammation, but it didn't do anything. New vet put him on Tylan powder and within 2 days, I saw slight improvement in his stool. Tylan is one antibiotic that is used to treat this bacterial infection. He will stay on it for a month.

 

His weight loss and muscle mass loss is due to the malabsorption due to this infection, but she thinks he was never very healthy to begin with. She thinks he has an underlying low grade IBD, and the immune function in his gut has been severely compromised, which means he will never be able to eat a raw diet. She recommends a veggie diet and veg/potato-based treats. No more lamb lungs. No more jerky treats. No more marrow bones. Instead of Milkbones, Old Mother Hubbard veggie biscuit treats. He doesn’t seem to love his salmon kibble b/c he won’t eat it for bkfst, only for dinner. She agrees we need to find something that he will eat twice a day and that will work for his stomach. She will send me home with a high quality venison based kibble for sensitive stomachs. He needs to like it and eat it heartily, he needs to gain weight.

 

I urge you to ask your vet to run these tests BEFORE doing a biopsy. I thought I was going to the best vet out there, and I will still see her for everything else. But there are other things that specialists are necessary for, and I am so glad I found the second vet who is a specialist in these issues and ran a boatload of tests (although extremely expensive) that found the culprit ad now that we know what we are dealing with, we know how to treat it.

 

Please let us know what you decide and find out.

Claudia

[Guest BiancasMom]

What about endoscopy? No incision there. Or find a place that can do a laprascopic biopsy. Very small incision with that.

[charbess]

What about endoscopy? No incision there. Or find a place that can do a laprascopic biopsy. Very small incision with that.

My understanding is that only a biopsy can get a yield a sample from deep enough in the tissue. We went through this recently with our Charlotte, and like you, chose not to put her through this procedure for the sake of knowledge. She was 10.

[Guest Greyt_dog_lover]

what about an allergy test with all the different proteins and such? We just had a foster in our group that was allergic to nearly every protein except Lamb. poor thing cant even have sweet potato. The hound is much younger but was adopted out and lost 25lbs in 1 month and the adopter gave him back to the group as opposed to getting to the bottom of the problem. The above post about a second opinion and different tests is something else I would try.

[greyhead]

Spencer had this trouble in late 2008, as he turned 8 years old. Intestinal malabsorption was found; they tested for it after I reported him eating wood (window sill, rocking chair leg). That didn't solve the problem, though the B-12 helped enormously, and I was told the next step was biopsy. He'd lost over 10 lbs. at that point, and the only point of biopsy was to determine if there were inflammatory cells at work and, if so, what kind. Thing is, the treatment is substantially the same regardless! Meanwhile, his poop was getting more and more smelly and vile and I asked (three times) for a culture-and-sensitivity on it, which turned up a raging case of SIBO involving a vast overgrowth of two strains of Clostridium perfringens. I'm really glad we didn't cut into his intestines and risk spreading that! Instead, we did an ultrasound after we'd controlled the SIBO but he was still not right. That showed inflammation, lymphangiectasia, and thickened intestinal walls, chiefly in the area where the small intestine leads up to the large, and the findings were consistent with moderate to severe IBD. Endoscopy wouldn't be able to reach the area. With my vet's concurrence, we declined doing a surgical biopsy because it wasn't going to affect the treatment and he had by now lost almost 20 pounds. We treated with budesonide instead of prednisone since he couldn't afford any more weight loss. Budesonide targets the GI tract specifically and doesn't cause weight loss (though it does cause fur loss, slowly over time). He also required metronidazole and tylosin, as well as L-glutamine supplementation and a 1/3 raw diet composed entirely of venison and sweet potato. (That's why continually changing food proteins is a bad idea; they will develop a permanent inflammatory response to every new protein until the inflammation is controlled.)

 

So that's our story, and I hope it helps. I should add that Spencer lived four and a half years after that, died of something entirely different, and at that time had an ultrasound which showed that his intestinal walls were back to normal in terms of thickening and inflammation. Actually, Spencer died from the drugs given for a liver biopsy. So I'm not a fan of biopsies on older dogs if they aren't going to change the treatment.

Edited September 5, 2013 by greyhead

[MaryJane]

I just went thru this with my new senior. I adopted him 6 weeks ago. He had healthy poops for 4 days, then out of nowhere, he started explosive, uncontrolled diarrhea. He became severely dehydrated and had to be hospitalized for 2 days, to get rehydrated, tested and treated. he was sent home with Flagyll and I/D prescription food. With treatment, he was able to control when he pooped, but it never actually improved in consistency. The smell is deadly. full blood panel and fecal culture showed that he did not have worms, but as a result of the severe dehydration, he was unable to absorb nutrients from his food. his racing weight was 78 lbs, back in 2006. He was down to 70 over the 7 ys he was retired in his prior home. Dropped to 63 at the time he was hospitalized, just 10 days after I adopted him. Appetite is great but severely skinny and loss of muscle mass. Brought back to my grey expert vet when there was no improvement, other than slight weight gain. She didn't know what else it could be and suggested a biopsy. I absolutely refused to put him thru that.

 

Luckily, I am part of a large greyhound walking group and one of the women had a similar issue with her grey, years back, when she adopted her. She recommended I get a second opinion from her vet who is an expert in stomach/intestine problems. I went Saturday for that second opinion, and although it cost me $850 in labwork, I am so greytful I did! She tested for all kinds of things that my grey savvy vet didn't think of. And just today we got the results we were looking for, got an actual diagnosis and treatment has already begun. She took blood, urine, and fecal, and tested for everything else they don't normally check for. GI panel test for maldigestion vs. malabsorption. Fecal panel test for infections (not parasite and giardia which had been tested and came back negative already). Cortisol test which screens for Addison's disease. These were all things my grey savvy vet never thought to check for. Thank dog he doesn't have Addison's, but he does have an infection in the intestinal tract caused by CAMPYLOBACTER. This specific bacteria can be very damaging to the intestinal tract, causing severe inflammation, and stops the body from absorbing nutrients and most importantly, B-12. He had a B-12 shot Saturday, as vet suspected this was going on, and he started feeling better that nite. He will have to get a B-12 shot once a week for a month, and once a month for the rest of his life. This specific bacteria is also resistant to most antibiotics, like Flagyll. He was on low dose Prednisone for inflammation, but it didn't do anything. New vet put him on Tylan powder and within 2 days, I saw slight improvement in his stool. Tylan is one antibiotic that is used to treat this bacterial infection. He will stay on it for a month.

 

His weight loss and muscle mass loss is due to the malabsorption due to this infection, but she thinks he was never very healthy to begin with. She thinks he has an underlying low grade IBD, and the immune function in his gut has been severely compromised, which means he will never be able to eat a raw diet. She recommends a veggie diet and veg/potato-based treats. No more lamb lungs. No more jerky treats. No more marrow bones. Instead of Milkbones, Old Mother Hubbard veggie biscuit treats. He doesn’t seem to love his salmon kibble b/c he won’t eat it for bkfst, only for dinner. She agrees we need to find something that he will eat twice a day and that will work for his stomach. She will send me home with a high quality venison based kibble for sensitive stomachs. He needs to like it and eat it heartily, he needs to gain weight.

 

I urge you to ask your vet to run these tests BEFORE doing a biopsy. I thought I was going to the best vet out there, and I will still see her for everything else. But there are other things that specialists are necessary for, and I am so glad I found the second vet who is a specialist in these issues and ran a boatload of tests (although extremely expensive) that found the culprit ad now that we know what we are dealing with, we know how to treat it.

 

Please let us know what you decide and find out.

Claudia

 

 

Spencer had this trouble in late 2008, as he turned 8 years old. Intestinal malabsorption was found; they tested for it after I reported him eating wood (window sill, rocking chair leg). That didn't solve the problem, though the B-12 helped enormously, and I was told the next step was biopsy. He'd lost over 10 lbs. at that point, and the only point of biopsy was to determine if there were inflammatory cells at work and, if so, what kind. Thing is, the treatment is substantially the same regardless! Meanwhile, his poop was getting more and more smelly and vile and I asked (three times) for a culture-and-sensitivity on it, which turned up a raging case of SIBO involving a vast overgrowth of two strains of Clostridium perfringens. I'm really glad we didn't cut into his intestines and risk spreading that! Instead, we did an ultrasound after we'd controlled the SIBO but he was still not right. That showed inflammation, lymphangiectasia, and thickened intestinal walls, chiefly in the area where the small intestine leads up to the large, and the findings were consistent with moderate to severe IBD. Endoscopy wouldn't be able to reach the area. With my vet's concurrence, we declined doing a surgical biopsy because it wasn't going to affect the treatment and he had by now lost almost 20 pounds. We treated with budesonide instead of prednisone since he couldn't afford any more weight loss. Budesonide targets the GI tract specifically and doesn't cause weight loss (though it does cause fur loss, slowly over time). He also required metronidazole and tylosin, as well as L-glutamine supplementation and a 1/3 raw diet composed entirely of venison and sweet potato. (That's why continually changing food proteins is a bad idea; they will develop a permanent inflammatory response to every new protein until the inflammation is controlled.)

 

So that's our story, and I hope it helps. I should add that Spencer lived four and a half years after that, died of something entirely different, and at that time had an ultrasound which showed that his intestinal walls were back to normal in terms of thickening and inflammation. Actually, Spencer died from the drugs given for a liver biopsy. So I'm not a fan of biopsies on older dogs if they aren't going to change the treatment.

 

 

The information in these 2 posts is very good. I would suggest checking what they have suggested rather than going into a biopsy.

 

I might also suggest moving to a homemade cooked diet of veggies, rice or potato, and a protein - preferably meat (maybe fish). Do not use not chicken as they indiscriminately add antibiotics to the feed and that will make the any GI problem worse as it gets rid of the good bacteria.

[Guest Fasave]

Lots of good ideas in this thread. I had an IBD pup diagnosed with endoscope. It's a tough disease. What turned him was working with a nutritionist that developed a diet for him based on his bloodwork and test results. He also had PLE AND PLN. One needs low protein diet and the other a high protein diet so he was a challenge. The nutritionist I saw was in Boston and she's moved to NC. One of my friends just consulted with her via phone so that is an option. Let me know if you are interested.