MURPHY'S VET VISIT

[Jane, Guinness and Murphy]

I'm including this update here because yesterday Murph and I spent 90 minutes with our Vet, and I received probably the best explanation of chronic gastrointestinal disease in dogs ever.  My Vet has a way of breaking things down and making them understandable.  I know that many of us have these issues with our Doodles, so I thought this info would be helpful to share.  I took Murph because he has had three episodes of severe diarrhea in the past month, and lately his stools are soft most of the time.  She examined him (including a rectal exam) and extracted a sample of his feces.  She did note that the feces in the colon was very soft as she took the sample.  She also had to empty his anal glands which were full, probably because of all the soft stools.  Then she did the fecal cytology while we waited.  The results of that were not good....lots of activity, including bacteria (that doesn't belong there) and red and white blood cells.  The body was trying to fight of the bacteria in the intestinal track.  The exact cause of chronic gastrointestinal disease is not always clear in spite of the diagnostics.  So, what she is suggesting is that we take a staged approach to his therapy.  I need to maintain a diary to monitor his "clinical signs" and we will introduce treatment pretty much one thing at a time.  This will help to understand if his case is diet responsive, antibacterial responsive, immunosuppression responsive or a combination.  Here's the plan for the next few weeks...

-No dietary modification at this time (until we see the results of the other therapies).

-He is on Metronidazole which is an antibacterial drug.

-He is on panacur to rule out any parasites that could not be detected in the fecal sample.

-He is on proviable which is a multi strain probiotic.  I did tell her that I was giving him 2TBSP plain yogurt daily, and she said that is "nice", but would not be effective as a probiotic with his issues.

-I need to pick up an additional medication today which had to be ordered....I'm not clear on what that's for.

I mentioned to her that his severe episodes were always after highly excited or stressful events.  She said that stress can absolutely trigger an attack, but the underlying "disease" must be there for this to occur.  In other words a dog who has no gastrointestinal issues would not have severe diarrhea simply due to stress. 

It is very possible that diet management will be our next step.  There will be two key considerations in developing a diet for Murphy.  First, it will have to be highly digestible which limits what's available for metabolism by intestinal bacteria.  Protein would be restricted to a single source.  The diet would also have to be high fiber.  That piece is actually pretty complicated and we will have to determine whether a low solubility or higher solubility fiber diet is most appropriate for him (that will probably be trial and error).  We will probably end up with a home cooked diet with specific supplements added.  This diet will need to be much more "precise" than Guinness's home cooked diet.  Guinness (although he also has chronic gastrointestinal disease) did not have the same abnormalities in his cytology that she saw with Murph yesterday. 

That's the brief summary.  I actually have pages of notes from my visit yesterday.  The good news is that Murphy is a very healthy dog.  The bad news is that this is a complex disease.  The prognosis with careful management if good. 

What are the odds of two dogs (both ALDs but from completely different backgrounds) would end up with GI disease?  I also wonder as I read so many postings about other dogs who display similar symptoms if there is some genetic predisposition with Doodles.  I'll keep everyone posted, and hopefully what I'm about to learn will help others along the way.

[Karen, Jasper and Jackdoodle]

I'm sorry to hear that poor Murph has tummy trouble of this magnitude. It makes me think more than ever that there was a reason he ended up with you. had he been adopted by someone else, he'd have had a fecal test and gone home with a case of Hill's.

I know that you and your vet will figure this out, and i also have no doubt that a lot of us will learn a great deal along the way.

Hugs to you and the big guy.

[Jane, Guinness and Murphy]

Thanks, Karen.  I must admit that I'm a little "overwhelmed" right now about all of this.  I have much to learn.  I'm just so fortunate to have a Vet who is so knowledgeable and so willing to take whatever time is necessary to be sure I understand what's going on.  She adores Murphy....and he feels the same way about her.  It's quite the little "love fest" between the two of them.  He will let her do anything to him with no reaction at all.

[F, Calla & Luca]

I'm sorry to hear of Murphy's troubles and I hope he's better soon. Some of what you said about the bacteria in his feces did not make medical sense to me but it certainly seems like he may have some sort of colitis. It would be difficult to tell just from cytology what kind of bacteria one is dealing with aside from general form.That may have been what your vet was talking about. The bulk of feces is composed in large part of bacteria. Metronidazole also treats some parasites. You are doing multiple things at once, i.e. several medications, which may make it more difficult to sort out what actually helped. I don't know that ALDs have a higher incidence than other dogs of GI disease. We hear more about the dogs with problems. I have two ALDs with no GI problems, aside form the rare too many treats induced runs. Someday maybe we should look at this but I doubt we'd get a good sample since the interested responders would more likely have dogs with problems. People whose dogs have no GI problems don't post about that. We do all have a lot to learn for sure.

[Jane, Guinness and Murphy]

Thanks, F.  I think what she was saying was that the intestinal bacterial microflora was unbalanced - too much harmful bacteria.  The cytology was able to show that, and the red and white blood cells would also support that.  She explained that she has a diagnostic "hierarchy" ...first rule out parasites, then the bacteria (intestinal flora) route, then dietary modifications, and lastly glucocorticoids (very rare).  She also prescribes probiotics as what she termed an "adjunctive therapy".  He will likely stay on these indefinitely and they are not really diagnostic.  She's doing the parasite treatment at the same time as the antibacterial, but she didn't seem to concerned that would be a problem in terms of complicating the diagnosis.  We'll have to see.

[Jane, Guinness and Murphy]

I just talked to the Vet....I had to go pick up another medication.  I asked her the question about how she could tell from the cytology what kind of bacteria was present.  She said without a culture she could not tell specifically, but she could determine that there was an imbalance which is confirmed by all the white cells she saw.  Then she started "getting technical" and she lost me.  So, you're right, but she did have enough info to determine there was an imbalance, but not to determine specifically if she was dealing with colitis, IBD, or "clostridium (with a second name I can't remember)".  She said either way she would be going down the "same treatment path".  Does that make sense?

[F, Calla & Luca]

Not sure really if it makes sense except for the beginning of treatment being the same for all. I suppose if you are used to seeing normal fecal flora in dogs you could tell if there was an overgrowth of one kind. Eventually if the diagnosis is more specific the treatment may be. There are many kinds of clostridium but it certainly can be C. difficile.

[Donna K & Quincy]

Has Murphy been on antibiotics, C dif usually happens when antibiotics knock out the natural bacteria in the bowel.

[Jane, Guinness and Murphy]

No, he hasn't been on any antibiotics since September when he had the Rocky Mountain Spotted Fever.

[Nancy, Ned, Clancy, and Charlie]

Poor Murphy.  I am so glad that you are his mom, Jane.  Whatever the final diagnosis is, I know that you will persevere in the best outcome.

[Hunter and Daisy's Doodle Mom]

I'm so glad you were able to get some answers.  I can relate how frustrating it can be when you know there is something wrong and they can't tell you how they're feeling, you can only look into their eyes and try to make them understand that you're trying to help and get it fixed.  My two are on a homemade diet and quite honestly, we are not spending much more for the ingredients and supplements than we were for a high-priced dry food they were on before. It had to be tweeked a few times, but now it is perfect, they have had no digestive issues in almost a YEAR and they are healthy as can be.

Again, I'm glad you found out something.  It will be a lot to learn at first, but you'll catch on quicker than you think right now.  At first I thought, I got two broken dogs...then I thought, "I hope the other people that adopted out of this litter took the time to find out what was going on", but then I realized that God brought me to these two because He knew I would take care of them, and I'm sure He did that as well with the other families.  And I'm sure He did the same for you! :-)

 

[Mary Reams]

My previous dog, an Airedale, had similar symptoms and was diagnosed with "leaky gut" syndrome.  Basically, she was not able to digest protein efficiently.  I consulted with Monica Segal, a dog nutritionist, and she helped develop a home cooked diet (venison & sweet potato) with supplements added gradually.  My doodle has not problems with digestion or stools since we changed to a single protein kibble of venison and sweet potato. Her recent physical exam indicated she was very healthy, with stool sample normal.  Good luck with your doodle.  You can also check with yahoo group K9Kitchen for dietary advice.