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Alright...Loose Stool Dog, update 12:45pm--ACTH results back.

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  • Alright...Loose Stool Dog, update 12:45pm--ACTH results back.

    We did the ACTH for Addison's yesterday. I don't have results yet, but the plan is that if he isn't diagnosed with Addison's, we're going to start him on prednisone to see if we can't shore up the loose stool issue.

    I did give him Tramadol for a few days to see if that affected the growly sigh thing when he would lay down. It did. So I'm convinced that there is some discomfort.

    Energy level is good, eating/weight is good, we're still just dealing with this latent loose stool issue. Even on the Endosorb and 45 days of probiotics, he's still having soft stools though at least for now, they're not liquid anymore.

    I took him off of the Z/D and he's back on the California Natural Herring and Sweet Potato. I don't think it was a food allergy.

    He's not on any prescribed medication right now. Just Endosorb and Fortiflora.

    I am hopeful that we'll have the results of the ACTH back today. If not today, Monday. But if it's negative for Addison's and we do prednisone, I'm just wondering what it is we're trying to accomplish?

    I'm not having a ton of luck getting info out of the new vet. So I'm wondering if you all who have been following along might help me find information on this matter.

    Far as I can tell, if we give pred, we're just parts changing. There's no real diagnosis but it's the treatment angle you'd take if you suspected lymphoma, right?

    Any thoughts?

    I'm going to be offline this afternoon but I would love any reference info you could point me towards. I've googled the heck out of Addison's. I just don't know what the other path means.
    Last edited by BuddyRoo; Jan. 18, 2013, 01:46 PM.
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...

  • #2
    Yes, prednisone would be the likely treatment for lymphoma as well as for IBD or PLE. I wish you luck. I cannot think of any other testing you could do which might provide an answer.


    • Original Poster

      Thank you Marshfield.

      It's terribly frustrating. I doubt very much that it's Addison's. If it IS, it's very atypical. But I can deal with it if that's the issue. If it's NOT, I don't know that there's anything else to do but the pred.

      I feel like we're in a black hole right now. I think all of the veterinarians have essentially given up and we're kind of on our own leaving me to drive the process.

      I don't much like that.
      A good horseman doesn't have to tell anyone...the horse already knows.

      Might be a reason, never an excuse...


      • #4
        I have a dog with addisions and thankfully is doing very well now. What were the electrolytes like. A high K would make me suspicious of addisions. Hope you get news soon


        • #5
          I would be very hesitant to put a dog on prednisone without a compelling reason to do so, such as a firm diagnosis of a condition that definitely responds to the drug.

          Look up "inflammatory bowl disease". Often once triggered this condition keeps going even in the absence of the original cause.
          the only way to definitely diagnose IBD is by endoscopy/biopsy, and usually it's a "we ruled everything out first, then we did this final test" sort of diagnosis- which sounds kind of like your situation, right?
          The vets tend to treat IBD by prescription diets/ medications, which helps but does not cure, but many people report complete resolution of the condition after switching the dog to a raw diet.
          You could just do a trial run of a raw diet- many stores sell pre-made raw diets, you could buy a couple week's worth and see what happens. Cheaper than vet tests, and more fun for the dog.


          • Original Poster

            Janice--his bloodwork has all been good. No elevated K. I really doubt it's Addisons. But gosh, it would be nice if it were and we could treat it!

            Wendy--Yes, we already did the biopsy.

            I'm just so worried about doing raw with the bones, the history of pancreatitis, etc. I'm totally scared. But maybe that's the next step if we have no answers. I just want him to feel better. And I want to stop renting rug doctors.
            A good horseman doesn't have to tell anyone...the horse already knows.

            Might be a reason, never an excuse...


            • #7
              OK - I've forgotten some of the history.

              Did you find an internist?

              What did the biopsy show?

              How long did you try the z/d?

              Prednisone is a great anti-inflammatory and if there was evidence of GI inflammation on the biopsy it might quiet everything down. My IBD dog had to have a month of prednisone (1st time since her diagnosis 7 years ago) when she ate something (squirrel poop?) in the yard she shouldn't have.

              It would also treat lymphoma, but that *should* have shown up on the biopsies as well...


              • Original Poster


                No worries on not remembering, that's why I keep posting. I can barely keep it all straight myself!

                An internist at MSU has been working on the case but relying on the vet here to send info and that has been somewhat problematic due to her case load I think.

                I have another line on a clinic with an internist.

                The biopsy was fairly benign. It was of the small intestine near the previous anastomosis site. They actually did two. There was nothing of concern on the biopsy.

                Did the Z/D for 6 weeks. No change unless you count the change to my bank account!

                The lymphoma thing was the original thought on day one of all of this but was ruled out with the ultrasounds, bloodwork, biopsies, etc, but I can't help but think it's still a possibility due to his age and the original symptoms.

                He had lost about 20 lbs, was off food, having loose stools. That was the original presentation. But he's gained it all back, stools are not liquid now with the Endosorb on board. All blood work has been golden. Fecals good. Have done about 6 fecals and a fecal culture. U/A's have been normal, also did a culture there.

                He did the Tylan, metronidazole, etc for awhile too. No improvement.

                At this time, he seems fairly happy and healthy. It's JUST the stool issue. But that's kind of a big thing because I can't be gone more than a few hours or sleep more than a few hours without an accident in the house with the loose stool.
                A good horseman doesn't have to tell anyone...the horse already knows.

                Might be a reason, never an excuse...


                • Original Poster

                  Just got results of ACTH on Giais but don't know how to interpret them. Have to leave soon to take a friend to the Dr so don't know if I'll get to talk to the vet soon. Anyone familiar? First sample was 2.0 normal range 1-5. Second sample was 15 normal range 8-17.

                  Addison's or not?
                  A good horseman doesn't have to tell anyone...the horse already knows.

                  Might be a reason, never an excuse...


                  • #10
                    Keeping fingers crossed, BuddyRoo. Had the same issues with my cat Oliver and it turned out to be IBD. Pred is controlling it nicely. But sheesh, the co$t!
                    What's wrong with you?? Your cheese done slid off its cracker?!?!


                    • Original Poster

                      I think the test shows us that it's NOT Addison's and we just need to treat with pred. le sigh.
                      A good horseman doesn't have to tell anyone...the horse already knows.

                      Might be a reason, never an excuse...


                      • #12
                        Usually a ACTH stim levels <2 (pre and post) are supportive of Addison's (depending on the units, of course).

                        I think at this point, your best chance of getting to the bottom of this is to take the entire previous record/results to a local internist.....I would probably do that before starting pred if possible.


                        • #13
                          there aren't any bones in commercial raw diets- they grind it up finely. It looks like hamburger. It's perfectly safe to feed- Stella n Chewy brand even guarantees the food free from pathogens so it's safe to feed to immunosuppressed animals and safe for people who can't remember to wash their hands after handling it to feed as well.
                          If you don't have freezer space, you can get freeze-dried and air-dried versions.
                          If you're worried about pancreatitis, lower-fat raw diets are often recommended for such dogs- the ideal "prone to pancreatitis" diet is high in protein and low in fat. The kibble you're feeding doesn't meet that description. Primal's rabbit and venison raw formulas are ideal for pancreatitis-prone dogs.


                          • #14
                            Have you considered making an appointment with a holistic vet and trying another approach? We had loose stool issues with our pup from the time we got him as a 3 month old stray from a rescue. He did come to us with worms and giardia, but even after clearing giardia, he was still failing to thrive. Tested negative for EPI, etc. All regular vet could suggest was a prescription diet, but which one and why couldn't be answered, and I didn't understand the point of that. I finally decided to try a holistic vet, and he went on a home cooked diet (formulated by her) and supplements. We no longer have him on the supplements, but we do have him on the home cooked diet and he's been on it for 1 year now. He immediately started having normal stools and gained the much needed weight, and is now a normal healthy 2 year old dog who eats better than I do!


                            • #15
                              A few years ago our barn cat (who does have EPI and takes Pancreazyme daily for the last 10 years) lost 4#, developed diarrhea, and had no appetite. Everything looked great otherwise- bloodwork perfect, urinalysis perfect, x-rays perfect. We performed fecals and broad spectrum dewormed him (he is a barn cat after all!) and we may have put him on Pred too. At the same time I had a litter of feral kittens LOADED with coccidia so I ended up treating ALL my cats with Albon. The Albon completely fixed whatever was wrong with the barn cat. My vet said sulfa drugs sometimes do good things for GI problems. Not sure if it will help you at all, but wanted to share.


                              • #16
                                An Addison's dog will show very little rise in cortisol in the 2 hour post reading. In fact, more often than not their pre and post cortisol readings will be low and very similar.

                                I have a Cushing's dog and he recently went in for his 6 months ACTH stim to make sure we're not overtreating him which could cause an Addison's crisis. His pre-cortisol was <0.7 and his post was 1.2. We immediately took him off the meds for a week and then restarted him on a lower dose. Many Addison's dogs will have a cortisol reading below 1.0 both pre and post test.

                                A normal, healthy dog will show a rise from pre to post cortisol, after the injection of the ACTH of 3 to 5 times the baseline cortisol. An Addison's dog will have an already low baseline and will show very little or no elevation after receiving the ACTH.

                                Here's a good blog that describes it in very layman's terms:


                                Of course, there's always the 'atypical' cases of Addison's as well...
                                Random horse pics http://www.flickr.com/photos/glfprncs/
                                Talk to me about fitness or nutrition (I'm an A.C.E. Certified Personal Trainer)!
                                My blog! http://personalsweatequity.blogspot.com/


                                • #17
                                  So frusterating. I really wish one specific internist up my way would come see you. We have 4 here in our hospital, but one in particular is just amazing.

                                  I would see how he responds to pred. Worse case scenerio it doesnt help, then you stop it. If it helps, you likely have an IBD/Lymphoma that was not captured on biopsy. I would also think its likely more of an IBD. If its been this long, typically dogs with lymphoma go downhill without pred or chemo.
                                  Jingles for solid poop soon.


                                  • Original Poster

                                    I'll say that I'm rather disappointed in the fact that i never did hear from a vet today. Aside from you here.

                                    I called twice. Was even told that someone would call around 7pm and call in the pred so we could get it started this weekend. Nothing. Not a danged thing.

                                    I'm so displeased. But as my husband said, "Do you want to sound like a crazy dog lady who is pissed because her dog didn't have a problem and you want a phone call?"

                                    Well no. Of course not. But I'm still pissed because I've been doing this for MONTHS. MONTHS! I'm so bloody tired of it all. Maybe there are other options. Maybe the internist will have thoughts. But not likely if she doesn't get the damned results! We were all waiting on this today.

                                    Me, the surgeon, the internist. All of us waiting. And the only reason I got values was because I insisted that the receptionist give them to me.

                                    Trying to be cool. I am. But I've spent far too much time and money to not be a little tweaked right now. He could already be taking the pred tonight if someone would've just picked up the damned labs and looked at them.
                                    A good horseman doesn't have to tell anyone...the horse already knows.

                                    Might be a reason, never an excuse...


                                    • Original Poster

                                      Squish, I would be willing to pay a consult fee and send all of the records to the doctor you speak of if he/she would be willing to just take a look. I'll pay for the time.
                                      A good horseman doesn't have to tell anyone...the horse already knows.

                                      Might be a reason, never an excuse...


                                      • #20
                                        Originally posted by BuddyRoo View Post
                                        Squish, I would be willing to pay a consult fee and send all of the records to the doctor you speak of if he/she would be willing to just take a look. I'll pay for the time.
                                        I know exactly what he would want to do. First, since you have already had the ultrasound done, obtain the measurements of the mucosa, muscularis and serosa in each section of the intestine (ileum, duodenum, jejunum) and measure the wall of the colon as well.

                                        Start dog on prednisone trial (or, if you are anti prednisone and want to try another food, do that - generally, just make a change).

                                        Re ultrasound in 2 weeks after starting pred (or 6 weeks after change of food). If diarrhea has subsided, the layers have likely changed and become less inflammed. This will tell you that he has a responsive disease.

                                        You can always assume that its a steroid responsive disease if the diarrhea stops as well. The goal is to always wean off, or maintain at lowest dose possible. However, often times the starting dose needs to be worthwile. You will have side effects at first (increased thirst, urination, panting and hunger), but once you wean down to a lower dose these side effects usually disappear.