ACTH results came in normal so we are set to start on a 2 week trial of prednisone. 10mg twice daily for 7 days, then 10mg once per day for 7 days, then 10mg EOD til done.
I haven't started yet pending some input from other veterinarians who are looking into this case. HX below. But I guess that's where we're headed. If anyone has objections or something else to say, please do now. I'm only going to wait about another 24 hours before I get started on this.
Patient: 9 1/2 YO black lab, no chronic issues, very active, good weight.
Dec 2011, perforated bowel due to foreign body (squirrel vertebrae), was septic. Side by side anastomosis was done, 30cm small intestine removed. Recovered well. At that time, they did ultrasounds and radiographs trying to rule out cancer as well. All clear abdomen and thoracic.
Aug 2012, started going off of food intermittently, some loose stools, losing weight. At the time, thought it could be stress due to kids moving out, husband moving to DC, packing up house. CBC/Chem panel, U/A, fecal all good. Put on I/D and metronidazole.
Sept 2012, Continued to be off food, losing weight, no fever, all other vitals good, energy good. Blood work good. Did a dental cleaning to check teeth and make sure nothing going on there. Stayed on I/D, wasn't eating it well.
Oct 2012, Presented to Michigan State University. Suspected lymphoma. Blood work good. Abdominal ultrasound revealed some distention above previous anastomosis and some foreign bodies in stomach (cardboard). Radiographs of thoracic cavity showed no abnormalities. Anastomosis was revised to an end to end by the same surgeon who performed the procedure a year prior, another 12 cm of bowel removed and biopsied. Biopsy showed no abnormalities. Went home on pain meds (tramadol, gaba), I/D, probiotics. Recovered from surgery well, but initial symptoms persisted. By this point, was down to 70 lbs from 94 and at 94 lbs was fighting fit. Stopped pain meds, did a power pak in case of undiagnosed Giardia. Began feeding boiled hamburger and rice. Appetite iffy. Liquid stool persisted.
Nov 2012, Moved to VA. Symptoms persist. More blood work (good), another fecal (good). Started another round of metronidazole, probiotic, and switched to California Natural Herring and Sweet potato per vet in VA. Appetite improved. Began putting weight back on. But explosive liquid diarrhea continued.
Late Nov 2012, Switched to Z/D. Appetite better, put on weight, loose stools persisted. Began using Kaopectate to "buy a little time" each day.
Late Dec 2012, Loose stools persisted so dropped the Z/D, back to the California Natural, added Endosorb (biosponge) and stools firmed up a bit. Still not terribly controlled. Cleaning up lots of loose stool if I don't get up during the night to let him out.
Surgeon and Internist at Michigan State recommended via email correspondence after seeing current labs to do ACTH to rule out Addison's as a last ditch effort and then start on prednisone if the ACTH came back normal. Gave the food/Endosorb a chance for about 6 weeks.
CURRENT: Did ACTH last Thursday. Starting was at 2.0 (normal range), ending was 17.0 (normal range). Not Addison's based on my understanding of the labs, have not heard from vet. Is back to normal weight and activity level. Eating well. Urine is fairly dilute but he drinks/urinates a lot normally. Stools are typically soft serve, but controllable for the most part on the Endosorb. Finished a 30 day round of probiotics Sunday. Can go about 4-6 hours without having an accident. Is giving some indication of pain (groaning when lying down that resolves when given Tramadol twice daily).
We normally walk between 5-10 miles per day. Activity level is good. He's still a very energetic lab.
A good horseman doesn't have to tell anyone...the horse already knows.