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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 9557
Experience:  Over 20 years of experience treating cats, dogs, guinea pigs, hamsters, rats, mice, and iguanas
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Looking for treatment and pathogenesis for irritable bowel

Resolved Question:

Looking for treatment and pathogenesis for irritable bowel syndrome in the dog. Dog is 13 years old, Greyhound, presenting with loose watery stools, and bouts of inappetance. On 10mg, oral prednisone for last 14 days sid, on Vegan dry food, mixed with sweet potato, pumpkin, potato mash....stools became normal last 5 days, but beginning Monday started loose then watery stools again, with no appetite...upped prednisone to 20 mg....today (5/22) by tonight appetite back...stools pudding.....David XXXXX, DVM....Looking for long term treatment...better medications....etc.

Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Kara replied 1 year ago.
Hello, my name is***** have over 20 years of veterinary experience and I'd like to help with your concerns about Amy.
It will be important to try and characterize what sort of loose stools she is having as well as the frequency of stools to try and localize the problem. Loose stools with mucous or bright red blood with increased frequency and straining, even when there is nothing to pass, point more towards large bowel diarrhea or colitis. Watery stools with no mucous or straining but weight loss and sometimes vomiting points more toward small bowel disease.
Given what you have told me I would be most suspicious of small bowel diarrhea with Amy's symptoms.
Small bowel diarrhea or inflammation of the small intestine, can be due to stress, a change in diet, parasites, a bacterial, fungal or viral infection, inflammatory bowel disease or even a food allergy. Unfortunately an infiltrative cancer such as lymphoma or adenocarcinoma are other possibilities.
Chronic diarrhea does cause changes in motility of the gut and can lead to reflux and vomiting. It can also lead to bacterial overgrowth in the gut. Probiotics such as Fortiflora or Benebac can help replace appropriate bacteria, so they are well worth trying. Probiotics are usually more helpful with small bowel diarrhea and not as helpful with large intestinal diarrhea. In some cases combination antibiotic therapy with amoxicillin and metronidazole for 10 to 14 days are very helpful.
If she has not had stool samples and a culture checked to make sure that parasites or abnormal bacteria aren't part of her problem they should be done. I would recommend a complete blood count as well as a biochemistry profile to check for any signs of internal organ disease as well as any changes in blood protein levels. At her age liver disease and kidney failure are certainly possible underlying causes.
Is she losing weight?
It is possible that she has a food allergy/sensitivity or inflammatory bowel disease and that she needs a different food or a hypoallergenic food to be able to properly digest and absorb her food and not have loose stools. I highly recommend a trial of a hypoallergenic diet, for example either Hills z/d or Purina Veterinary Diets HA. If those aren't helpful then Hills i/d or Purina Veterinary Diets EN can be tried. No treats, table food or edible chewies while she is on her food trial. If she does well she can eat these foods for life as they are balanced. Sometimes we need to try a few diets before settling on the right one.
Dogs with inflammatory bowel disease will worsen with stressful situations. There may be times when she will need medications too, such as metronidazole or even steroids or other immunosuppressive drugs if that is her problem, but I have found that a consistent, easy to digest diet is very helpful for long term control.
There are other possibilities too, though they are less likely given what you have told me.
Addison's disease, which is a poorly functioning adrenal gland, can lead to chronic diarrhea and vomiting. These dogs cannot handle stress at all because their adrenal gland doesn't produce cortisone when stressed and their electrolytes can be off too if their adrenal gland isn't controlling that normally either. We see vomiting, diarrhea and sometimes physical collapse in severely affected dogs. Testing is an ACTH response test to check adrenal gland function and checking electrolyte levels. Treatment is steroid replacement therapy and electrolyte replacement.
Pancreatic insufficiency is another possibility. These dogs have a pancreas that produces a decreased amount of digestive enzymes, and the amount produced can wax and wane in some cases, especially early in the disease process. Testing is by running a blood test called a TLI which checks for digestive enzymes. Treatment is replacement of digestive enzymes at each meal. An easier to digest food would be expected to create less problems with digestion and as such less diarrhea. We usually see more of a small bowel diarrhea with pancreatic insufficiency however.
In short since this is a returning problem for your girl then more diagnostics need to be done. They can be as simple as a complete blood count and biochemistry profile to assess general health, testing for Addison's disease or pancreatic insufficiency. Or they can be more invasive such as biopsies of her gastrointestinal tract to look for inflammatory bowel disease or infiltrative cancers such as lymphoma. Given what you have told me and her response to steroids I do suspect that she has some sort of primary bowel inflammation and that biopsies may be needed to diagnose it. Because she has already been given steroids however they may not be diagnostic now, as the effects of steroids may mask the primary condition. In some cases steroids are not enough and we need to add other immunosuppressive drugs, such as cyclosporine. If you don't want to put Amy through collecting biopsies I would recommend at least a biochemistry panel to look for underlying organ malfunction and then trying dietary modification and antibiotic therapy with probiotics.
Please let me know if you have any further questions.
Customer: replied 1 year ago.

Yes, she is losing weight. I am a retired Veterinarian, in small animal practice over 40 years. Her blood report from Jan 2012, within normal ranges except Creatine which was 2.0 mg/dl and normal on this lab is 0.5 to 1.8. There is no vomiting. Stool samples have been parasite negative. checked 3 times in last 60 days. Her diet just before the acute onset was Taste of the Wild "Wild Boar" for 4 months...Initially put her on both diets suggested above but no changes even with pred and probiotics....put her on Natural Balance Vegan and saw improvement with Pred and Probiotics...slowly changed to Natural Balance Synergy and relapsed...she is back on Natural Balance Vegan with 20mg pred first 24hours, 10 mg pred twice daily for today 5/23 with added mirtazapine 7.5 mg per day. Appetite has perked and stools are pudding consitency at present. The pattern seems to be this....when good she has formed stools, medication stayed same...pred 10mg once daily...diet slowly moved to synergy (meat based) and she relapsed after 72 hours on total synergy. After 72 hours watery but controlled stool.....3-4 times a day...8 hours later appetite wanes to non existent and she appears depressed...would eat pieces of bread but no normal dog food. Increased pred to 20mg....5/21 and began mirtazapine as dietary stimulant 5/23 a.m. and increased appetite p.m. 5/23 Stools appear pudding consistancy. again no vomiting at any time. Just curious, are you associated with Blue Pearl Veterinary Associates. Thank you, ***** ***** DVM

Expert:  Dr. Kara replied 1 year ago.
Dr. Wyatt, thank you for the further information about Amy. I am not affiliated with Blue Pearl Veterinary Associates. I'm actually fairly new to California, we came here via my husband's job transfer.
If her creatinine was elevated in Jan 2012 I am concerned that part of this may be due to the effects of increased amounts of kidney waste products on her gastrointestinal system. I do recommend rechecking a BUN, creat, calcium and phosphorus and looking at a urine sample to check for concentrating ability and protein spillage.
However I don't think that primary kidney disease is the whole problem given her response to dietary manipulation and steroids. I do think that there is a protein in Natural Balance Synergy that she is sensitive to. Given that most protein is digested in the stomach and small intestine and she seems to do poorly with higher protein foods either we have a problem with the stomach or small intestine and/or her kidneys. Both problems could be contributing to her weight loss.
It makes sense that she doesn't want to eat when she is experiencing diarrhea as that means her disease process is active and she likely has a fair amount of cramping and discomfort at that point. An acid reducer may be very helpful. You can try either:
1) Pepcid-ac (famotidine) at one 10mg tablet per 20 to 40 pounds of body weight every 12 hours.
OR
2) Prilosec (omeprazole) at one 10mg tablet per 20 to 40 pounds of body weight every 24 hours.
If her kidney values seem static and her urine looks good, and you do not want to put her through biopsies, I would leave her on Natural Balance Vegan as a permanent diet, use steroids (pred) twice daily for 10 to 14 days and then very slowly decrease to the lowest effective dose. I would also put her on a 21 day course of Amoxicillin and Metronidazole or Tylosin. If she gets diarrhea again then consider adding Azathioprine (Imuran)and using it with Pred long term.
Unfortunately at her age we do need to consider that this may be an infiltrative cancer, and then her response to would make sense as well. I truly hope not, I hope that this is just inflammatory bowel disease that can be controlled with diet and medications.
Please let me know how she does, I have a huge soft spot for greyhounds as we are on our second rescue greyhound fellow. Both of my boys have had IBD and it can be a real balancing act to control, so I feel your frustration.
Take care, and please give me an update as you have time.
Dr. Kara, Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 9557
Experience: Over 20 years of experience treating cats, dogs, guinea pigs, hamsters, rats, mice, and iguanas
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