Gi contd

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Customer: Gi contd
Answered by Denise Nelson in 8 hours 2 months ago
Denise Nelson
Pet Specialist

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Specialities include: Dog Veterinary, Dog Medicine, Dog Diseases, Small Animal Veterinary

Dr Nelson - so your last response was this past Friday. I did submit a fecal sample on that day with results taking a week. I dont think this is the reason as his bowel movements have been pretty good for the most part including the last week. However its been now a week where he has eaten less or not wishing to eat anything mixed even with wet kibble that has cheese and minced chicken. I would then offer him a slice of cheese which he ate plus a square inch of pork as a test if he would have an appetite for that. He weighed still 44lbs on Friday but today has dropped to 43lbs. When I walked him yesterday, he was scouring anything possible he could find on the sidewalk. Over the last week - pepcid has been reduced down to 5mg. This morning he vomitted yellow bile and was given 10mg at 10am. I made the decision today that trying to break him behaviour wise to take kibble would be given up upon. At lunch time, he got a few slices of white cooked rotasserie chicken without skin. He ate it but it came out within 1/2 hour. I gave him 1 pepto tablet. As mentioned it has been given sporadically only. So my fine DVM wont entertain anything else til the fecal results come in. I presume his bile vomit was the result of a number of consecutive days low food intake. How does one steer this at the moment. When I got him almost 3months ago, he did consume some kibble in combination with meats. His intake was significant over the three weeks he was on prednisone. Its been a month now off it and was able to retain 3 of his 4 gained pounds. His last week food intake has been poor but his demeanour good.
he stole a piece of apple pie this afternoon. He got 1/4 chicken breast with accidental 1000 to 2000 iu of vitamin d as liquid probiotics look the same bottle. I now belong to the silly mass who can't double check. Hopefully everything stays down below. Whether is recent steep food intake decline is behavioral or physical. Whatever the cause he has had it since 6 months.
Hi there! I'm glad to hear that Tiko's stools have been good and he acts like he feels well, but I'm sorry to hear he is still vomiting and his appetite is still poor. Did Tiko ever get to try the Bil-Jac? 

Fortunately the dose of Vitamin D Tiko got is not toxic (Vitamin D can be quite toxic for dogs at high doses.

Please let me know the results of the fecal culture. If no issues are found, then you may want to ask your vet about endoscopy to look for inflammatory bowel disease.

the good news - he kept down the apple pie/chicken breast for the remainder of the evg. I gave him another 260mg of the pepto - 2nd dose and last one hopefully for this incident. He appears to have an appetite for human foods. To what extent he might gouge, I havent given him the opportunity. But realized after him vomitting the bile today, there is no purpose in pushing this further. Did get the Bil Jac chicken/liver kibble today. It resembles small rabbit feed pellets. Its dry and yes, I taste it to see it. I did offer him a few pieces and he ate but wasnt overly excited. I bet you a shiny nickel the culture wont show anything meaningful. Arent these type of tests inconclusive to what they yield? Guess we will see. I dont know what the liklihood of a puncture is with an endoscopy and with a vet clinic which is tooo busy. I did price out the Encyte. It appears pretty pricy - a 30ml bottle will last 2 weeks on the recommended dosage. I am willing to give him a combo of kibble/cooked meat every day. I did span out on this site and a Dakota vet inferred he might very well be too adjusted to a meat diet then to flip him over again. This vet inferred getting him on the Encyte awhile and then using Metamucil and pectin products to help calm the gi tract down to get him to eat better. As mentioned, his BMs have been pretty good the last week while his appetite has dropped. I am amazed he is able to output anything on the small caloric intake. As mentioned, I have attempted to get him completely the pepcid gradually as he was never on it when I got him. At the 3 month mark - he is still moody with me quite often. But he flirts with my mother daily and nice to all the incoming personal service workers. Gnite
The primary reason for fecal culture is looking for overgrowth of any normal intestinal bacteria, and also to look for bacteria that can cause illness such as Salmonella, Clostridium, Campylobacter, etc. If something abnormal does show up then Tiko can receive specific treatment for it. If no abnormal results then it is another thing that we know it isn't. Unfortunately veterinary medicine is often a process of testing for things that could be causing the symptoms. A negative/normal result tells us one more thing that is not the underlying cause, and we just have to keep testing until we find the right answers. It can be exhausting and frustrating for both the owner and the vet.

Introduce the Bil Jac slowly so as to not overwhelm his system with a new food. I'm glad he was at least willing to try it - that's a hopeful sign!

The risk of a perforation with endoscopy is about 0.1% so not common at all.

I was actually wondering if Tiko needed more fiber with his propensity to steal baked goods, so the Metamucil is definitely worth a try. Kaolin/Pectin can help soothe the lining of an irritated GI tract, so is also worth a try, but if the underlying cause of the GI irritation is inflammatory bowel disease then it won't provide long term management. The Entyce is certainly worth a try as well to see how he responds to it.

Dr Nelson - again I thankyou for your contd insights. So I havent heard from my vet and will be calling in tomorrow since its been a week since she wanted the fecal sample. I had already mentioned Tiko for almost a week ate poorly. I offered him good portions of meat/cheese but with kibble. So he was probably averaging 1/2 cup of human food at best for a number of days but his BM's were well formed. They were smaller but almost daily. He had been a good week on reduced Pepcid at that point 5mg down from 10. Since he did vomit bile on Tuesday - I surrendered the notion of breaking him behaviour wise to take the kibble mix or get nothing. He got 2 Pepcid on Tuesday and vomit was once on Tuesday am. Yesterday - he got a larger chicken breast in the am, in the afternoon a small cup of white rice with two beef stir fry strips (less than 100g). He seems like these low grade Pedigree beef marrow biscuits - so he got three of those during the day. This morning he got me up early at 7am. He had a larger BM - the first part well formed, then the remainder a softer mound. Half an hour later - he again had a small BM which was diarrhea. I took him for a walk mid morning and he defecated a small amount of fluid. I gave him a Pepto after that. He also was bumped up to 10mg Pepcid this early am morning. He seemed in good spirits for most of the day. He had no fecal visits for the rest of the day even after a 2nd walk. Not wishing for him to get nothing again - I forced him to eat a smaller chicken breast to get something into him. So hopefully he will hold it. I guess for the smaller chance he is harbouring some organism - he would get metrondazole for a few weeks. I dont think this is the cause but guess will see. He hasnt got the daily Boulardii as much as he used to. I put alot of stock in that probiotic to yield a decent BM. I have priced out Entyce to be 150 dollars a month if he gets 2ml a day. He weighed 43 lbs a couple of days ago so he still has been able to retain 3 of 4 pounds. I would like to get some closure on this or at least some confirmed diagnosis what it truly is and how to steer it. I dont trust my vet to do an endoscopy even if time permits for her but I digress
He got two PEPTO on Tuesday that is
Also he drank perhaps 1/4 cup of lactose free milk this early am but doubt that would precipitate the BM issue for today. I read in his historical DVM bio - he ate milk

If I'm reading and interpreting correctly it sounds like Tiko did not have any kibble on Tuesday and Wednesday and then had diarrhea today. And when he was having formed stools he was getting some kibble daily....  Just an observation....    I wonder what would happen if you left a bowl of dry kibble out for him to snack on whenever he felt like it? Perhaps a mixture of the Royal Canin and the Bil Jac? Just a thought as to be honest I'm running out of ideas of how to entice Tiko to eat better, not vomit, and not have diarrhea. Since he does seem to respond well to the Pepto, I do think the Kaolin/Pectin would be worth a try. The Entyce is definitely worth trying as well. It can be given on as needed basis, so that may make it a little less expensive if the effects are lasting longer than 24 hours for him.

I hope the fecal culture provides some answers as well. It would depend on the type of organism found whether he would go on Metronidazole or a different antibiotic.

The only other thought I have is that sometimes I would test for inflammatory bowel disease with a trial run of Prednisone when the owner could not afford endoscopy, surgery, etc. We've already seen an improved appetite with Tiko on low dose Prednisone. The catch is then he has to be on Prednisone long term, possibly life long, which can have adverse effects over time.

Dr Nelson - after not hearing back from my vet for a week and before the weekend sets in again. I did call the clinic. My vet was again not available but the results were in already. I advised unless the results were poor, I would hold off until speaking to her next week. Her backup colleague didnt even know of the drug "Entyce" when I spoke to her a few weeks ago. Anhow, I infer the results were acceptable. After being on s boulardii for a few weeks now, I didnt think he would be harbouring anything. For the most part, his BMS have been satisfactory. I looked at my log from when I got him. His BM's in the first month when he was at least on 50 percent or more cooked meats - his BMS were decent even before the Boulardii. For a dog you have never even seen physically, you have been for the most part remembered small fine details about both IKOs. But your point above with him having diarrhea when he hasnt had kibble is incorrect. Also even if I left out any sort of kibble, he will naturally not go for it. That is has been my primary concern the last two weeks. The prednisone was stopped Oct 26th/2022. Over the following month - he would eat a good cup of food each day being mixture of kibble/cheese/meat. Then a good week back, he wouldnt touch the kibble mixture anymore. I resorted to giving him 1/2cup of cheese/meats if that.
One day he only ate a slice of cheese. But on each of those consecutive days, he was originally offered a full cup of kibble mix. I was hoping with each passing day, he would take the kibble mixture as he must be getting angry. Pepcid was lowered at that time from 10mg to 5mg. Anyhow this past Tuesday after a noticeable lower food intake for a number of days - he vomitted the bile. As mentioend prior, I thought forget the kibble. He got 10mg pepcid and 2 pepto on Tuesday. On Wednesday, he ate a full chicken breast in the am and in afternoon - again 1/2cup rice with a couple of minor beef strips (less than 100g), 3 dog biscuits and small danish. Yesterday he had about three diarrhea incidents but again with one pepto in later of the day - he got a small chicken breast with the aim to get food into him. Fortunately today, he has had no BM and he got two boulardii capsules. This morning he got 10mg pepcid. I was able to get 1/2chicken breast into him with 1/4 cup Bil Jac and 1/4 cup shredded cheese. My goal was for him to eat a small meal in the am and the bigger one in the pm. But no such luck - I test him by putting a whole piece of chicken breast in front of him, it was a no go. I tested him with the beef strip, again no interest. Then there is no purpose of a kibble mix. I know you stated regular pepto would not be good but thought if this was gi related, maybe he would take the food an hour later - no such luck. I did weigh him today again and he weighed apprx 43 lbs. So he has been able to retain 3 of the 4 lbs. He has only lost 1lb in the last two weeks with averaging at times with less than 1/2 cup of human food. A normal dog would have shown interest in the beef strip. I already asked my vet a good month ago about Entyce and feel some valuable time has passed. The prednisone option is not viable in the long run due to his young age. I shall request the Entyce but even if it helps him, its most likely masking something. I shall ask her about an endoscopy but will see as I just dont have confidence in her. Gnite
I guess if Entyce has any pull - he might be able to get a mixe of food with the granular supplements such as pectin
Dr Nelson - you can close this question after your final comment. My vet finally got back and wanted to put him on mirtazapine. I have hesitations as its an anti-depressant and what occurs if he comes off it (even poorer). She is consulting with a GI vet. I did ask another online vet about this new med and he inferred a non systemic steroid.
as another option. There is no definintive proof he has inflammatory bowel disease so dont wish to introduce it
He has been given three days of this drug at 15mg
This will be my last entry. .He also got a deformed today. I will stagger these two meds a few days apart. I think I shall taper off a bit with bugging you. You have been an excellent resource. But what I have found now with vets, weak peripheral symptoms exist and one tries to test for anything remotely related
Pancreatic insufficiency would have him eating vs what he is ailing him. If had some intestinal worms, there would be more clear-cut symptoms
dewormer that is
last note she prescribed the 15mg every 72 hours for three doses

That's fine if your observations do not align with mine; the lack of kibble and the diarrhea was simply an observation based on one data point from your last post.

Many dogs prefer to eat just once daily; perhaps Tiko is one.

The Kaolin/Pectin is generally in a liquid form, which you could give him directly by mouth (Durvet is one brand name). The liquid form will also do a better job of coating the possibly irritated lining of his digestive tract. However it will also decrease absorption of any other medications he is taking.

The Pepto can be given as needed, it just shouldn't be given chronically long term.

Mirtazapine is an older medication that was used regularly for it's side effect of appetite stimulation before we had the Entyce, which was specifically formulated as an appetite stimulant. The Mirtazapine generally works quite well, should be less expensive than the Entyce, and it does make sense to do a trial with it to see what the response to an appetite stimulant is. Please let me know how Tiko responds to the Mirtazapine.

I am so glad to hear that your vet is consulting with a GI specialist. Please be sure to let me know what the GI vet's take on things is. Giving a dewormer is also a good move as sometimes dogs can have intestinal parasites without microscopic evidence in their stool, and symptoms could include intermittent vomiting and/or diarrhea and lack of appetite.

I really do understand how frustrating and exasperating not having any answers yet is. As I stated before, it is a process of ruling out things it could be. Unfortunately it's not as simple as Oh, he has a poor appetite so that means one diagnosis only.  Exocrine Pancreatic Insufficiency usually results in increased appetite, but can also sometimes result in decreased appetite. As I said before - the dogs don't read the textbooks! I think the GI Specialist will be pleased with the work up your vet has done so far, and would likely recommend the test for EPI and the fecal culture if it had not been done already. I'm pretty sure the GI vet will recommend Endoscopy next, but I will be very interested to hear what they recommend.

I hope the Mirtazapine works well for Tiko!

Dr Nelson, the lady with always a strong sliver of optimism in her vet. outlooks.
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Denise Nelson
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