Chronic GI Upset in a Dog: Diagnosing Precious—GI Issues That Are Not Going Away
Precious was ill since the end of the year. An exploratory surgery, three vets, four months, and several treatments later, he was not getting better.
His guts were not happy and nobody could figure out why.
Precious’ story
Precious was a 3-year-old Rottweiler, happy and always healthy prior to this event. The problem started on the 29th of December after Precious overindulged at the Christmas dinner.
He woke up feeling miserable threw up and had diarrhea.
His vet prescribed Enroxil [enrofloxacin] 150mg, 2 per day for 5 days. Things improved for a while only to return with something worse after only a few days. The vet suggested a prescription diet.
In a few days, however, Precious further declined. His veterinarian prescribed Metronidazole.
Still, Precious’ condition continued to worsen. Precious was straining unproductively and when he did manage to pass something it was an explosion of terrible smelling greenish liquid.
I went to the vet again and was told that it could be another month of taking this medicine before I could see some improvement. Asking what do I expect during the month I was told that his condition may worsen or get better at times.
The vet who has known him since he was a puppy never examined him.
I wasn’t comfortable with this, a month had passed and Precious was worse than day 1. I couldn’t imagine letting him suffer for another month.
Getting a second opinion
I took a video of Precious doing his thing and I called another vet who visited Precious at home.
The new vet suspected IBD but recommended we take x rays and ultrasound just in case there was an obstruction. And so we did on the 29th of January.
Xrays didn’t show any swallowed object and I was confronted with the difficult decision of exploratory surgery. I was told that something could be hidden in his colon like for example a ball of bones and precious could die if we don’t act immediately.
Exploratory surgery
I signed the paper for surgery.
After a while, I was told that no object was found but his intestines are very sick.
I asked if it was cancer and the answer was definitely not but his whole intestines and the colon are very inflamed. I asked for a biopsy but the vet said that the inflammation was so bad that he would be risking perforation.
Precious was given Rodogyl [Spiramycin, Metronidazole a combination of two antibiotics] for 10 days after the operation.
His incision healed well and things were for the following 2 weeks. The straining was gone and the stools were solid.
Precious’ relapse
After the two weeks, however, the straining and explosive diarrhea came back.
Precious was given one medicine after another, Rodogyl, Salazopyrin [Sulfasalazine], Rodogyl again.
Up to all this time besides this problem, Precious remained quite happy looking forward to his drives and walks, playtime and ate as usual. The vet decided to give him 20mg of Prednisolone a day.
In the evening of the 2nd day, I noticed that Precious was panting and was very restless. His tummy was very hard and felt swollen.
I took him out walking and he passed a lot of gas and the biggest explosion of poo ever. The color was yellow and the smell terrible!
I reported this the next morning and prednisolone was to be tailed off.
Trying more treatments
After this, the vet wanted to try another medicine. after another course of Flagyl, Prifinial chien, he said, would help regulate intestinal motility.
Although hesitant I gave him this medicine and this was the end of happy Precious. He would just lay there, miserable, his tummy swollen and he didn’t even pass gas.
On his walks, he strained and strained only to pass a few drops of poo.
Seeking a third opinion
I just couldn’t keep up the trial and error of different medications and decided I should, after all, seek another opinion. I hoped to find someone who wasn’t scared of my baby.
So I finally got to the 3rd vet on the 1st of April.
Although I hoped for a miracle medicine that could make my Precious better the vet told me that he will definitely not give Prednisolone to Precious unless further testing is done and he is sure of his organs, mainly the liver. He sent out for more labs.
He gave Precious Hyoscinth to help with the flatulence problem and Lactulose to cleanse him whilst reducing the straining.
Precious is in a terrible shape
The following week was the worst ever! Precious just lay on a quilt and just slept. He ate very little and didn’t even want to go for his walks.
His lips and mouth were cold and he just stayed curled up alone.
Precious throws up
On the 7th of April Precious woke up and vomited something that looked like plastic.
I thought I was imagining things, after all, it was just 4 AM, but in the afternoon during his little walk, he vomited again.
My dad was with me and said I should probably keep it and show it to the doctor. I kept it in a bag and the vet told me to take a picture, however, I did not and just threw it away thinking it was all in vain.
On Saturday 9th April after some serious straining, I couldn’t believe what went out of Precious’ behind! With an explosion of poo came out what looked like a whole roasting bag all covered in mucus!!!
An improvement?
After that Precious seemed to have been gaining back his health. He was eating and up from his quilt again. It seemed that with the plastic the problem went away.
However, it did not. Precious seemed fine, however, his stools were still watery and they looked like clay!!
Precious was put on Denosyl [S-Adenosylmethionine] 225mg tablets twice a day. While it could be a coincidence, explosive greyish stools appeared on the same day.
The lab results suggested possible EPI (Exocrine Pancreatic Insufficiency) combined bacterial overgrowth.
We started Precious on a sulfur antibiotic and some digestive enzymes.
Precious refuses to eat the “enzyme tainted” food and was back to straining and explosive diarrhea.
More lab work
Nothing detected in the ultrasound. Waiting for blood work result.
The doctor said Precious needs to be taking the digestive enzymes and gave me in pill form. He said Precious was suffering from Irritable bowel disease and when I said I wanted to find out what’s causing the inflammation he said the only way would be a biopsy and test it abroad. The test is not available in Malta.
He suggested I give Precious digestive enzymes twice a day and see what happens. About the ammonia or rancid smell, he said since the food was not being digested it’s causing fermentation in the intestine hence the bacterial overgrowth. He was almost certain that there was no obstruction however we could do a barium x-ray. I am not willing to take the risk for this (Precious won’t drink it).
Precious feels better
Precious was getting better. He was taking the digestive enzymes in capsule form and eating ZD hypoallergenic diet 4 times a day. Still taking antibiotics.
His stools became non-explosive, not watery, still greenish in color but no ammonia smell and solidifying. checking for Giardia again.
Nothing abnormal in blood work.
Precious’ energy started coming back and his lovely barks are back. stools still greenish but forming, no explosions and no ammonia or rancid smell. He was taking 4 meals a day ZD which surprisingly was looking forward to. I give him also Florentero every day and digestive enzymes before each meal.
Precious’ lab results
Stools culture and microscopy Salmonella/Shigella species Negative Campylobacter species Negative No parasites and ova observed using high power magnification.
pancreas elastase (EIA):
PE-Konz.: > 180.00 µg/g > 40 (fragl. 10-40)
*Interpretation
Pancreas elastase reflects the endocrine function and was not influenced by sample age or inflammatory processes like the TLI-test.
The test is specific for the dog and not suitable for other species.
Microscopical examination
Starch granules : negative
Starch : negative
Neutral fat : negative
Fatty acids : negative
Fatty soaps : negative
Muscel fibres : moderate concentration
Connective tissue : negative
Elastic fibres : negative
fatty acid (near-infrared-spectrography):
total fat faeces / g/24h < 4.5g/24h
total fat faeces 3.38 g/100g < 2.5
Gallensäuren
total bile acids 3.6 µmol/g < 2.5
Interpretation
The identification of muscle fibers in feces indicates altered digestion. In the differential diagnosis a pancreas insufficiency, resorption abnormalities in the small intestine or impaired stomach digestion are to be considered. High concentrations of fat in feces are an indication of insufficient fat digestion. One reason can be EPI, quite common cause as well is bacterial overgrowth Estimation of bile acids in the feces can give further information.
High bile acid values are found as a consequence of a bacterial deconjugation in the small intestine or in short small intestine cases. Because of the hygroscopic properties of bile acids, aqueous explosive diarrhea can be produced.
Initially, antibiotic treatment with sulfonamide and trimethoprim (3-5 days) should be performed.
By clinical signs of bacterial overgrowth of the small intestine, antibiotic treatment with sulfonamids and trimethoprim or tylosin should be performed (3-5 days).
Phenole, nitrosonaphthole, and indican: the result shows a bacteriological overgrowth in the small intestine or an increased protein decomposition in the small and large intestine.
Resolution
Eventually, a contrast scan revealed there was still some plastic left in Precious’ intestine. It didn’t show up otherwise but was the culprit all along.
Related articles:
Diarrhea/Runny Stools
Further reading:
Gastrointestinal Foreign Bodies in Dogs