IBD Diagnosis: Food recs, etc

[Nicole and Teddy]

Hi there! Just left a long string in the Medical issues group as Teddy has received an IBD diagnosis. The GI panel results indicated cobalamin and folate are slightly low. Pancreatic lipase and TLI elevated. Findings are consistent with small intestinal disease like IBD, dietary hypersensitivity, small bacterial overgrowth, and others. They are recommending we begin a novel protein or hydrolyzed protein diet trial that has a lower fat content, starting vitamin B12 (either by injections or oral supplement), a good probiotic (he's on VSL), and folic acid supplement. I currently feed Teddy a home cooked diet but am now leaning towards a "regular" dog food to control the IBD. In addition to peace of mind with knowing where ingredients come from, I am worried whether Teddy will "like it as much" and gobble it up like he does the home cooked brew. Any recommendations/thoughts are much appreciated. Thank you!

[Karen, Jasper and Jackdoodle]

When did he last get a B12 shot? With IBD dogs, (and it sure sounds to me like Teddy has IBD), you do need to continue those on a permanent basis. Once he was in remission, JD got them every month for the rest of his life.

The antacids also need to be given daily and permanently, not just when the dog is having symptoms. The Pepcid helps keep them from having symptoms. 
Also, you didn't mention a probiotic, which is absolutely crucial for all IBD dogs, and forever. 
Again, this disease is incurable. It can be managed, but you cannot stop the meds or supplements when the dog is doing better. 
It's not unusual for a dog with IBD to develop an immune response to their current food, particularly when they are not on any immunosuppressant drugs. That's what this disease is, an overactive immune system that will suddenly start reacting to something that previously wasn't a problem. You've been very lucky to have been able to manage him this long without the drugs. 
My fear is that if you switch him to another novel protein without first suppressing that immune response, he's going to develop an allergic reaction to the new protein, and sooner rather than later. With IBD, we refer to proteins introduced when there is an active flare/inflammatory response as "sacrificial proteins". You're basically wasting that protein, because the dog will not be able to tolerate it for long.
I really think you need to find an IMS or at least a knowledgable and experienced vet ASAP. He really, really really needs that B12 and probably at least one course of prednisone. It really can't wait weeks, IMO. 
In the meantime, the homecooked food might be your best bet. 

[Nicole and Teddy]

Thanks, Karen! I should have mentioned he is on a daily probiotic. When we were initially going through all this, the internist said we just needed to go through one (what I'll call) "round" of B12 and folic acid supplements. We did the B12 shots at home for I think it was 6 weeks, with one more at the end of 30 days and continued the folic acid supplements for that long as well. She retested his folic and B12 levels at the end of all that and since they were normal said we didn't need to continue. I do still have the bottle of B12 though so would just need needles to get him going again. I will also make an appointment for him. The one thing I'll say is that during all this, she always said the test results were "indicative" of IBD - we never had the endoscopy done to confirm the initial diagnosis. 

[Karen, Jasper and Jackdoodle]

Jack's IBD levels were always way above the norm, but we still kept on giving the shots; B vitamins are water soluble and the levels will drop if the body doesn't continue to get them from some source. B12 is not well absorbed from food, especially when there is any type of malabsorption issue in the GI tract, hence the injections. You never allow those levels to drop. I would venture to guess that if you tested him today, his levels would be low. I'd start the shots again. JD was on a shot a week for a month after his initial diagnosis, then a shot a month for the rest of his life, with a return to the weekly shots during flares. 

I know he was never definitively diagnosed, but he has or has had just about every symptom of the disease. The endoscopy would definitely be something I would strongly recommend, but I do understand why many people hesitate to do it. 

[Nicole and Teddy]

Thanks, Karen! He's been on the chicken and rice diet for the last few days and hasn't been doing well at all. I figured as much since it's a protein he's had in the past but was crossing my fingers because he usually does well on it. I have an appointment for him today though and will hopefully get him sorted out. I'll talk to the vet about it too but at this point I'm not sure what to feed him since he was throwing up with the Zignature goat formula and didn't do well with the homecooked chicken and rice. Do you think I'll just need to start him on a new Zignature protein blend and potentially have to 'sacrifice' it?

[Karen, Jasper and Jackdoodle]

If your vet can get him started on prednisone, you can probably feed the homemade chicken diet until you can get in to see an IMS and get that testing done. I really do think at this point, you need to do that. The prednisone should suppress his immune response enough that he will be able to tolerate it. However, I'd substitute potatoes (either sweet or white) for the rice.

The other option for diet would be an RX hydrolyzed protein diet. I hate Rx foods, but sometimes, you have no choice. Try to get Royal Canin rather than Purina or Hill's if possible. 

[Nicole and Teddy]

So the idea being that I shouldn't start him a new protein source until he's had the testing (endoscopy?) done and is stabilized from this current flare?

[Karen, Jasper and Jackdoodle]

Yes. You haven't got all that many "novel" proteins left, it would be a shame to waste one when we're talking about the rest of his life here. 

After JD was scoped, he was put on prednisone among other drugs, and for a week he was fed a diet of chicken and cream of wheat per the IMS's instructions. They wanted to get that inflammation down before starting him on a new food, so that his immune system wouldn't immediately react and a new protein wouldn't be wasted. 
So even if you don't do the scope, I would at least get him on something to suppress the inflammation first. Also, the B12 shots will help. They are not just to get his cobalamine levels up; B12 also helps with digestion and maintaining a good gut microbiome. It's a symbiotic relationship. 

[Nicole and Teddy]

OK- I will let you know how the appointment goes. We are just about to head out.

[Nicole and Teddy]

Just got back. She wanted to take a conservative approach first which, of course, means metrazidonole (sp??). Course of that plus weekly B12 shots for now and at the end of the month move to monthly, and also Royal Canin food. Hopefully after he stabilizes in 5 days or so, I'll switch to another protein source. She said if there's no improvement in 3-5 days to come back in for the steroid approach. Not ideal but I get why she wanted to go this route first.

[Karen, Jasper and Jackdoodle]

I think metronidazole is a mistake. But let's see how it goes. 
CRUCIAL to give him probiotics, separate from the meds by at least two hours. 

[Karen, Jasper and Jackdoodle]

And which Royal Canin food? If it's not HP (hydrolyzed protein), that's a HUGE mistake. If it's not HP, return it. 

[Nicole and Teddy]

I had a feeling you would say that about the metronidazole. I figured I could live with it though if he does well in a few days with the B12, food change, and probiotics. I have Proviable that I give him every morning but will wait 2 hours. The Royal Canin is the gastrointestinal fiber response. Is that good?