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Ana Bascunan
Ana Bascunan,
Category: Veterinary
Satisfied Customers: 103
Experience:  Small Animal Surgery Resident at University of Florida
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I have a 2 1/2 year old male German Shepherd. He weighs just

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I have a 2 1/2 year old male German Shepherd. He weighs just 60 lbs. He eats a large amount of food each day, but is not putting on any weight and loses weight easily. He gets diarrhea very easily if he eats anything other than his usual food. Yesterday I gave him an egg. He’s had them before. I ground up the shell in the blender (previously he hasn’t eaten the shell). He’s been up twice in the night with bad diarrhea.
He’s had a history of diarrhea problems since he was 4 months old, when he had a bad case of giardia and coccidia. The vet put him on a hypoallergenic kibble, but he didn’t really do very well on it. He’s also been on hypoallergenic tinned food, but that doesn’t seem to suit him either. I’ve tried feeding him BARF, which his guts seemed to tolerate well, but he hates it and refuses to eat it at all. He’s always been very fussy with his food. He improved after we had him desexed at the start of this year, but still eats everything very slowly.
His normal diet is a commercially produced sausage-like refrigerated dog food from the supermarket, plus daily probiotics and a spoon of cottage cheese. He doesn’t tolerate bones, which give him diarrhea. Lately, anything outside this diet seems to upset him.
He has a shiny coat, is normally full of energy and has a lovely temperament (though gets very anxious with dogs other than our other dog). But he is very underweight and bony.
Our vet has tested him for exocrine pancreatic insufficiency (EPI) and he is negative.
She has now recommended doing a full thickness biopsy of his small and large intestine as a last resort to understand what’s going on. I am terrified he won’t survive this operation as he responds very badly to antibiotics – more diarrhea. However, given he isn’t gaining weight and keeps having diarrhea, I’m at a loss what else to do but take her advice. Do you think this is the right next step?
JA: I'll do all I can to help. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about the german shepherd?
Customer: The vet has tried treating his diarrhea with antibiotics, but that hasn't worked. Obviously this has been going on for some time. He has stable periods, but then relapses. And the real concern is he cannot seem to gain weight.
Customer: replied 6 months ago.
Has my payment gone through? I got redirected while paying and now have lost the link to the payment page.

Hello, my name is***** and I'm happy to help answer your question about your German Shepherd. First of all, what is your dog's name?

Customer: replied 6 months ago.
Charlie

Aww what a cute name! One more question before I can prepare some information for you - when Charlie has diarrhea, would you characterize it as large or small volume, and is there increased urgency to defecate (does he run out and go several times or can he hold it as long as needed?), also - is there any blood or mucus in the diarrhea?

Sorry I guess that was 3 questions not 1 :)

Customer: replied 6 months ago.
It's fairly urgent. He wakes us up and manages to hold on while we get to him most of the time (he succeeded tonight). It's not a massive volume. No blood or mucus. He drops in several plops, moving around as he goes. The first plop is like a small wet cow pat, then they look more like splashes. I could send photos, but can't attach to this message as they are on my phone.

Ok great, thank you. Based on your description of Charlie's signs, it sounds most like large intestinal diarrhea (colitis), although it could have a small intestinal component to it as well. Large intestinal diarrhea is typically associated with increased urgency and small volumes more frequently.

Given the chronic duration of Charlie's GI problems, I don't think that intestinal biopsies are a bad recommendation, however I do think there are other routes you could pursue prior to surgical biopsies (especially since you are hesitant about the surgery).

First, abdominal ultrasound is a great imaging modality for evaluating the intestinal tract. They can evaluate wall thickness (which can become enlarged in cases of inflammatory bowel disease) as well as wall layering (which can become disrupted in cases of cancer). They can also look at local lymph nodes as well as liver, kidneys, etc. If Charlie hasn't had an abdominal ultrasound, that would be my first recommendation.

Additionally, since Charlie has had signs since he was a puppy, I want to make sure that intestinal parasites have been completely ruled out? There can be some tricky and unusual parasites that require special testing to rule out.

It's great that your vet tested for EPI, since German Shepherds are the poster child for that disease and Charlie's signs seem to fit well. Another consideration would be a gastrointestinal panel (for example there is one at Texas A&M) that evaluates Vitamin B12 levels and folate, as these are things that can be supplemented. This is a blood test that can be sent out by your veterinarian.

Overall I think that Charlie could benefit from visiting an Internal Medicine specialist (if he hasn't already). Internists are the diarrhea experts and they would be very thorough in evaluating Charlie and making recommendations.

Lastly, regarding the surgery - I don't think you need to be afraid of it necessarily, although surgery always carries some risk of complication. We perform intestinal biopsies routinely and the dogs typically do quite well afterward. That being said, if you are uncomfortable with the idea of surgery, then I recommend pursuing other options for diagnostics first.

Do you have any further questions regarding Charlie?

Please let me know if I can help any further. I wish you and Charlie the best!

Customer: replied 6 months ago.
Thank you. I'm interested by your information about the prospect of a biopsy - I had read that biopsies of the large intestine are very risky, and there is also the concern about his antibiotic intolerance.Please could you explain what a "gastrointestinal panel" is? I'm in Australia, and haven't come across this term before.Charlie had an ultrasound previously (nearly 2 years ago) which showed some thickening, which was assumed to be due to his issues with parasites.The vet has tested him more recently and is fairly confident the parasites are gone, though we are aware they can be hard to detect sometimes. When he had them he had varying levels of diarrhea until they were gone. Now he tends to go OK with reasonable to normal poop for a while, then something triggers another event. But even when his poop is OK, he really struggles to put any weight on and easily loses it.

Of course, I'm happy to explain. You are correct in that biopsies of the large intestine are not to be ta***** *****ghtly- the colon naturally contains a large number of bacteria and therefore cutting into it we run the risk of bacterial leakage into the abdomen (which can be life threatening). In most cases of chronic GI disease, we can get away with small intestinal biopsies only (especially if we have indication on ultrasound that the disease is diffuse and affecting the small intestine in addition to the large) and these are the cases that I refer to when I say we do this routinely and they do well.

In cases were there is only focal disease in the large intestine (meaning the small intestine is totally normal), we may recommend colonoscopy with endoscopic biopsy in order to obtain a diagnosis without taking a full-thickness sample. In rare cases a large intestinal surgical biopsy is needed, but those cases are done knowing that the pet is at increased risk of complications post-operatively.

The gastrointestinal panel I referred to is a blood test that is run at Texas A&M University (although there is likely a similar test available in Australia). Below is a link to their website where you can read more about the tests they offer.

http://vetmed.tamu.edu/gilab/service/assays

Also, since his ultrasound was 2 years ago and he was dealing with suspected parasitic disease at that time, it may be worth the expense to repeat it now. A lot can change in 2 years, and this could help guide you and your vet when determining where the biopsies should be taken (in hopes of avoiding the large intestine, as discussed above).

Have you considered taking Charlie to an Internal Medicine Specialist?

Ana Bascunan and 2 other Veterinary Specialists are ready to help you
Customer: replied 6 months ago.
Thank you. That's really helpful. I don't know of an Internal Medicine Specialist for dogs. Our vet hasn't mentioned this. I will ask her.

Of course! I'm happy to help! I wish you and Charlie the best!

Hi Lesley,

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

Ana Bascunan