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My German Shepherd has been treated for everything. Ready…

Customer Question
My German Shepherd has...

My German Shepherd has been treated for everything. Ready for this? The only thing we haven't tried at this point is Prozac.

Veterinarian's Assistant: I'll do all I can to help. What seems to be the problem with your German shepherd?

Chronic diarrhea since last Dec.
-Tested for full blood panel-nothing
-Tested for giardia-nothing but treated with Flagyl
-3 rounds of antibiotics since moving in Dec. 1 to the new place
-Pro-biotics
-Treated for pancreatic deficiency with crap hydrolyzed food with an absorbing enzyme-black diarrhea of weeks
-Prednizone -nothing
-Grain free food -duck
-Boiled hamburger and rice-nothing
-Boiled chicken and rice-nothing
-Par boiled chicken breast now for two montths- nothing
-Par boiled chicken breast with a little bit of pumpkin-a little less watery but not much improvement
-Par boiled chicken breast with soaked oats-just to fill his gut because he is starving-back to watery diarrhea :(
-Fasted in between bad cases of water only diarrhea
-have fed small amounts after fasting of rice only
- have fed small oats only
- ordered special drops sworn to help from Canada-nothing
-Kaeopectaid, pepto...nothing
-Muzzled him for a day to prevent him from getting into whatever it is-we think there is a bush up front (unfortunately 4 of them that are part of the landscape but can't prove it and don't know what the bush is (have tried to id) JR and I both can't handle him being muzzled.
-Not sure if he is eating cat crap despite having a gate up to the room where the box is
-Add that to a 7 year old in the house and the dog will quietly walk off with and will eat a napkin if you don't watch him 24/7
-Then, a bag of treats for the Huskies were knocked off of the refrigerator in the garage by one of the Siamese and of course they all partook in eating them (back to water)
-A cat pukes, Spruce finds it before we do
-A morsel of anything hits the floor (clean up crew Spruce in isle 9) before you even know what happened.
-We left him at the vet for two days several months ago and he fed him whatever he had in his office-normal poop.
-We went out of town for a few days-normal poop
-Some improvement is shown when we give him Trazadone so either it makes him tired enough to not eat whatever he is getting or it relieves him of the stress he is under -he is and always has been a neurotic dog when more than Colton, myself and the cats are around.
-This started when we moved in Dec 1 of last yearTo feed a raw not to mention impossible for me to feed 3 big dogs raw to keep any possibility out of the house (other dog food) and 4 ravenous cats. I would have to place my 7 year old on it too! I am pulling my hair now prepping the chicken but was willing to do it if I saw some improvement. I am seriously at a loss. My vet wants to open him up next but I am not sure that's the answer either. I am up to my ears in vet bills and remedies in addition to foods that have not worked. He needs to be crated for a week but it kills us, only allowed to be out on a leash and right back in to truly rule out something he has gotten into/has been getting into. Open to any thoughts but the raw thing is probably out. Add that to no sleep for either of us because someone is always running to let him out at 2 am and 4:30 to avoid yet another accident (there have been hundreds).

Veterinarian's Assistant: Could be a lot of things that cause lethargy. The Expert will know how to help your German shepherd. Is there anything else the Veterinarian should be aware of about your German shepherd?

Not lethargy, that is the furthest from

Submitted: 8 months ago.Category: Dog Veterinary
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Answered in 23 minutes by:
11/21/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 34,913
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Customer reply replied 8 months ago
Thank you.
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago

I'm sorry to hear of this with Spruce. There's at least one thing that hasn't been done and it's the most expedient (albeit costly) manner in which to determine the etiology of such chronic diarrhea and that's scoping and biopsy of Spruce's gastrointestinal tract. I'm going to post my entire synopsis of how I address chronic diarrhea but it sounds as if most of the diagnostics I'll post have already been performed and only scoping and biopsy remains as a viable diagnostic.

I would approach Spruce's chronic diarrhea in the following manner although the order in which I've listed the various approaches can vary:

1) Presumptive worm with over the counter fenbendazole (Panacur) available in many pet/feed stores. Fenbendazole addresses all of the nematodes (roundworms, hookworms, whipworms) as well as the protozoan Giardia. This should be done even if a fecal ova and parasite exam didn't reveal parasites. That exam is too often falsely negative.

2) If worming weren't helpful, perform a gastrointestinal diagnostic panel of blood and urine tests. This should include a specCPL blood test (most sensitive for detecting the presence of pancreatitis), a TLI blood test (to check for maldigestion), and serum folate and vitamin B12 levels (to check for malabsorption of nutrients). Fecal culture looking for the gastrointestinal pathogens Clostridium difficile, Clostridium perfringens, Campylobacter, and Salmonella can be considered as well.

3) If this testing didn't reveal anything untoward, an abdominal ultrasound should be considered. Ultrasound is the most sensitive and readily available imaging modality for the gastrointestinal tract itself. My concerns would be inflammatory bowel disease, lymphangectasia, and neoplasia (cancer) such as lymphoma and solid tumors such as adenocarcinomas.

4) Perform a hypoallergenic food trial in an attempt to identify food intolerance. Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Spruce's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (a hydrolyzed protein diet is my preference because it avoids the possibility of my patient being intolerant to even a novel protein). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

5. Scoping and biopsying of the gastrointestinal tract which isn’t performed soon enough in too many of these patients.

Please respond with further questions or concerns if you wish.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin
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Category: Dog Veterinary
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Experience: University of California at Davis graduate veterinarian with 45 years of experience

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