More problems with colitis... questions as serious issues may be involved

Gracie has gotten ANOTHER bout of colitis. The vet thinks the last was never really knocked out and came back. But they are also a bit concerned that she is very prone to this for some reason and blood tests and xray may be coming soon.

We are trying different med (Sulfasalazine) this time for longer period. She has taken this since Thursday afternoon and overall poops are better, EXCEPT the one after she gets up in the morning is still much looser and mucousy. Any reason why?? Is the med wearing off in the night as this is a drug that is given every 8 hours, not once a day.

We are keeping her on a bland diet (low-fat cottage cheese, rice, some boiled egg) for now until things get better. Poor thing has lost nearly 3/4 pound with this last long bout.

We also have her on Endosorb anti-diarrhea pill as needed and a probiotic gel once a day. Any other suggestions?

On the more serious front, if this does not resolve and she needs tests, are there things that Cavs are more prone to having that could cause chronic colitis?

Antibiotics don't last very long at body temperature, the highest concentration will occur about an hour after the drug is given, then decrease pretty quickly after that. So it's possible that factors into her morning loose stool.

The thing about GI problems is that once they start it's hard to fully recover from. The cells lining the gut get damaged so even if you get rid of the infection they are more susceptible until all those cells regenerate. Unfortunately, it's impossible to give the gut a "rest", so it has to work while it repairs itself.

If you haven't done this already scrub Gracie's food and water bowls, if they're dishwasher safe put them in there for a cycle. If something is growing in there it could be constantly reinfecting her.

Has she done a course of metronidazole (Flagyl)? Giardiasis can be hard to detect in a fecal, and isn't treated by antibiotics (it's not a bacteria).

Thanks....

Gracie did do a round of flagyl but not sure it was long enough. That is what we used for her first two bouts, which she got over much easier, but you are noting that there is long-term damage caused with each bout she has.

Vet wanted to try something different and over much longer period. They are finding higher levels of bad bacteria which indicates colitis, but I can try asking for better test of Giardiasis when we go back next week.

Her plates are from the dishwasher each time, but will make sure water bowl is scrubbed constantly. I also am thinking about the floor of the kitchen. She is bad about picking up a piece of food and dropping it on the floor... and then licking it up. We always wipe that up with warm soapy cloth, but I am thinking we need to disinfect using something safe for dogs. That is coming up next. If anyone has suggestion of safe floor disinfectant let me know.

I feel so bad for her!!!

Nicki knows this area well and might see this post and answer in more detail on possibilities -- one thought would possibly be pancreatitis which is seen at a higher rate in cavaliers than many other breeds so I'd be checking for that, as a start. I'd also consider getting her to a specialist at a vet school as they will be more familiar than a regular vet if the issue is more complex. I'd see what happens and if you get another bout, would start the larger investigation and if no luck in pinpointing anything, and she keeps getting this, consider a vet school.

I'd also be thinking food sensitivities and very careful elimination diets. Milk by the way is a common source of allergy/sensitivity so you might eliminate the cottage cheese. Try a tablespoon of canned pumpkin (plain, not seasoned pie mix) instead. Mine also respond very well to those colon-settling pastes like Prokolin sold over here -- not sure what is available in US.

Thanks Karlin.... your advice always appreciated

I had thought of pancreatitis too. She is getting only slightly better.... no mucous and not really runny, but stool still way too soft after 3 days of meds. We do have something like the probiotic paste you mentioned and she is getting that. She has had cottage cheese in the past without problems but maybe she has developed an allergy to it now. We can take that out for now. I hate to add anything new and the rice is so bland to her with just egg. She has never had white fish and I know she can't handle chicken.

We do have a vet school in the area that is very good and that is a great suggestion. They also run one of the two 24-hour emergency clinics in the area as a way to give their new vets practicing with old hands.

Decided to take Gracie today to a 24-Hour Vet School Hospital

North Carolina State University has an affiliated vet 24-hour, 365 days a year clinic that is very well regarded. I decided not to wait until Monday and take Gracie later today after she get some sleep and a little rice on her tummy. The likely will want to do tests to identify what type of colitis this is and also test for other things. This is the only place that can do this on Sunday and they have xrays and everything else on site. 25 vets, including diet specialists on site. So later this morning... that is where we are headed. Love the wee thing so much, so hope she is better....

Karlin... I just about always call her "wee Gracie"..... it seems to fit her so well. I am pretty sure she is Scottish anyway.... her favorite snuggle blanket is a plaid one that I bought in Edinburgh!

Good luck with your trip to the Vet school. Pancreatitis was one of the first thoughts that came to mind reading your thread.

To answer the question about safe disinfection of your floor - there's nothing harmful about steam cleaning it. No chemicals to worry about, and the high temperature of the steam will kill all the bacteria. Worth a try. I wouldn't be without my floor steamer. I also use my food steamer to steam their bowls (I don't have a dishwasher).

Let us know how Gracie gets on

I haven't been following previous discussion about the colitis, but have one thing to offer, and perhaps you are already aware and acting appropriately.

The probiotic should hit the gut a few hours before or after the antibiotic. This is appropriate for humans, and I would think for dogs as well. Otherwise, the antibiotic works on the (good) bacteria in the probiotic and less on the bad bacteria.

I also agree with Karlin's comments re: food sensitivities & allergies.

I hope you can get Gracie's colitis under control. Poor thing, she must be suffering terribly, as well as yourself with her bouts.

It may be too late - but if you think there will be tests done on Gracie today, she should be fasting. Blood chemistry should be done when a dog is fasting as well as radiographs and ultrasound. Abdominal ultrasound particularly should be done when a dog is empty - one of mine had one two weeks ago and even after a 15 hour fast, there was still a lot of feces in his colon so it was difficult to visualize anything. Same with radiographs - better visualization when a dog is empty. They will usually ask you to fast a dog 12 hours before tests.

The definitive test for pancreatitis is the Spec cPL, but what you've described does not make me suspicious of pancreatitis (you haven't mentioned painful abdomen or anorexia or vomiting). Ultrasound will also diagnose pancreatitis as the pancreas will "light up" in the presence of this disease. Your GP vet hasn't been suspicious of this.

http://www.marvistavet.com/html/body_canine_pancreatitis.html

EPI (exogenous pancreatic insufficiency) causes weight loss and a large volume of strange looking stools - so this would be a possibility although it doesn't seem to fit yet:

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=622458&sk=&date=&pageID=3

There are many possibilities - SIBO is another one - but it would be better if you had things narrowed down (small bowel versus large bowel, for instance) before I post a lot of links that won't be helpful at all and may be confusing.

Another thought - I wouldn't go to an emergency vet hospital to run tests - you are going to pay way too much money and you will get whatever vet happens to be on duty that day which may not be your first choice. If you want to get a specialist opinion, I'd look on the ACVIM site and use their search tool and find a board certified internal medicine specialist and ask for a referral. Your GP vet may well want to do some tests before giving a referral since it seems that there have been no tests done thus far. If so, you can always take the blood chemistry results, radiographs, etc. with you when you have the consult so it won't be a waste of money to get those done first at the GP vet office. You'll also have an opportunity to gauge how your GP vet reacts when you ask for a referral and how well your GP vet can work as part of a team. But you haven't really given the GP vet a chance yet to narrow down the possibilities since no testing has been done.

http://www.acvim.org/websites/acvim/index.php?p=3

FWIW, I generally prefer a specialist in private practice versus going through the vet school if I have a choice. Although you may save a little money using the vet school, you must generally go through the hassle of much longer waits, leaving your dog (sometimes overnight), dealing with the residents, etc., more than the specialist. An example is my seven hours of sitting in the waiting room recently at UGA (I am NOT complaining about this - it was well worth that time to be able to participate in the genome study and to see Dr. Platt who does not have a private practice). I much prefer the greater access to the specialist, more personalized treatment, no waiting, etc. that comes from dealing with a specialist in private practice if that is an option and assuming that the specialist that I want has a private practice. (My cardiologist and my internist are both in private practice, although I started with my cardiologist when he was at UGA.) The other advantage is that you can often be present during tests at a private practice and that isn't possible at a vet school. I've been able to be present at all of the echocardiograms and other ultrasounds that were not done in a university setting - that has never been an option at a vet school.

Just some food for thought.

Pat

waldor said:

The probiotic should hit the gut a few hours before or after the antibiotic. This is appropriate for humans, and I would think for dogs as well. Otherwise, the antibiotic works on the (good) bacteria in the probiotic and less on the bad bacteria.

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This info is correct - good catch!

Pat

thanks soooooooo much

We are doing ultrasound tomorrow and will be fasting. They did find out with xray that she is very slow todigest her breakfast. So turns out that showed something interesting. Her system is slowed down. Still waiting on most other results of blood and fecal tests She will get subcutenous fluids.

I GREATLY appreciate the info on probiotics! That is not anywhere on the package nor has any vet said anything about it. I will try to time it between her other meds. We are going back to flagyl. More later. Still at vet.

This is not really just emergency clinic but we will pay less to get ultrasound tomorrow rather than Sunday.

FWIW, my boy that had the abdominal ultrasound two weeks ago also has slow motility (lots of feces in colon after 15 hours and he generally only poops once a day). He is on a low maintenance dose of metronidazole (Flagyl) all of the time, but he is an older dog. This isn't something that I'd want to do for a young dog without doing all the possible testing to determine other options. The continuous low dose metronidazole keeps his mild colitis under control.

Another tip - metronidazole at Walmart is on the $4 list so you can get 100 tablets (250 mg.) for $10. And then splitting the tablets makes this a very cheap drug so I hope you aren't paying a lot for it from the vet's office.

Pat (speaking of subq fluids, I'm about to give them to my 13 year old shih tzu girl.....and fluid can also be purchased at Walmart for a fraction of what you pay to purchase from vet office if you ever have to give long term subq fluids)

Pat... you are such a fountain of useful information!

I just got home from clinic. I now have liquid suspension of metronidazole. That was sooooo much easier to give. I coated the applicator with cheese taste and down it went. I am to give her two half-milliliters per day. They also prescribed a tummy antacid for her twice a day as they think her tummy is now a bit aggravated from the action in her intestinal tract.

The one thing the xray found is that her tummy was pretty full still from breakfast (and some of that should have been further along) and her lower bowels are pretty full, but not the small intestine. The latter had pockets of gas in it but that's about all. So, like the food is moving along in clumps and then getting stuck. Maybe a blockage of some type is at play or she does have a slow digestive system.

I know that lately, she has not had a bowel movement in the afternoon/early evening as early as usual. It is not after 8 pm and used to be more like 4-5 pm. But I also think the bland diet could slow it up some too.... not much fiber to move things along.

Getting ready for tomorrow....

Her poop was better this afternoon in terms of being loose, but had spots of blood again. These had been gone but returned. I am sure the stress of vet clinic did not help but glad we are doing the entire diagnostic route tomorrow. Hope I can finally get some answers for the poor thing!

It sounds like there is a lot going on here, but two good probiotics are Fortiflora made by Purina backed by scientific studies and Florentero. They can be given every day for dogs with issues - but check with your vet.

Misha has had chronic colitis, often clostridium. He's a senior though. He is on metronidazole now and I'm waiting on a call back from his vet tomorrow about long term tylosin. He has had on and off diarrhea for 2+ years - on tylosin for 6 months and not a lick of problems when he was on it. Young dogs usually go on it for 6-12 weeks though I think if they have chronic problems. It prevents recurrence of bad bacteria.

I just read a study on Cheetahs that had chronic colitis. Once the colitis was resolving, they added fiber to their diets which helped prevent recurrence of colitis. They hypothesized that the fiber fermented in the colon which leads to volatile fatty acid (VFA) production. VFAs can feed intestinal cells and as acids decrease growth of pathogenic bacteria.

Reglan and propulsid are used in guinea pigs for GI tract motility issues. I know nothing about their possible use in dogs though.

Thanks MishathePooh

These are all good ideas to try. I think we have a good probiotic.... just not sure what diagnosis we will have if there is a more serious underlying cause or maybe they missed a worm diagnosis. She has not had any vomiting at all... only range of odd stools and diarrhea with periodic drops of blood. Could be just chronic colitis, worms, diet, etc. They did rule out pancreatitis today for sure. So that is good news anyway.

Off for ultrasound this morning!

Hoping with all these tests we find some answers!

Results of ultrasound and tests are back....

Well nothing major showed up after tons of tests related to colitis except to confirm this is lower intestine problem. So going to continue on with flagyl 2 times a day and antacid once a day. And no change in diet at all but smaller meals more often. May add teaspoon of organic pumpkin tomorrow. Will do a deworming just in case. If not better in a few days she will need colonoscopywith biopsy to see what is up in her colon .

However, the ultrasound did show odd thing for kidneys unrelated to colitis that we have to track down the road. It could be caused by getting subcutenous fluids yesterday but she has an area in both kidneys where there is dilation of a sac where kidneys empty to bladder. If still there in a few weeks, it is sign of possible kidney infection. She has NO other signs of kidney issue at all now so will just recheck in a few weeks.

They also found a small indentation in one kidney that likely has been there since birth. Likely not an issue but something to watch.

So....not many answers today but ruled out blockages and other scary stuff.

GraciesMom said:

Well nothing major showed up after tons of tests related to colitis except to confirm this is lower intestine problem. If not better in a few days she will need colonoscopy with biopsy to see what is up in her colon .

So....not many answers today but ruled out blockages and other scary stuff.

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It's not uncommon to find nothing significant with an abdominal ultrasound in the presence of colitis. But it's really good to be able to take a look around without anything invasive and to be able to rule out a lot of serious possibilities. The two abdominal ultrasounds that I've done recently to look at kidneys and bladder were both perfectly normal......and I don't regret doing them.......esp. since I got to be present and see everything myself.

On the other hand, it would take a VERY convincing reason for me to agree to do any kind of biopsy - in fact I would probably never do a colon or kidney biopsy. The big question to ask is "what is the biopsy going to tell me that is going to influence treatment planning?" Also, colon biopsies often come back with no diagnosis - even if you do multiple punches - because you've got to hit the spot where there is a problem, if there is a problem that will be diagnosed by biopsy. So.......I'd advise that you have a long conversation and understand exactly what will be accomplished by a biopsy and that you feel certain that is what you want to do rather than feeling that you can't say no because you are "just the client." And discuss empirical treatment before or in lieu of biopsy - trying elimination diet or other things to see if there is a positive response. I'll take a look at my notes from Michael Willard and David Twedt (veterinary internal medicine teaching gurus who presented last year at AVMA) and see if I can find anything helpful that they said.

Doing an ultrasound and finding nothing causes no harm; doing a biopsy and finding nothing not only can harm the patient since it's invasive but is also harder on the bank balance.

For the kidney finding, it sounds as if you are describing dilated renal pelvis. When they did blood chem yesterday, did they also do a urinalysis?

Pat

I have absolutely nothing to add, but just caught up with this post and wanted you to know I'm keeping Gracie (and you in my thoughts and prayers.

Were you able to put your insurance in place before all this started?