Levi-9 month old golden retriever (home from ER/ICU 3 days)

[jilbert57]

Lisa, are you documenting what you are doing or keeping a log?

For now keep things the same but add in the slippery elm.

See if that helps at all. Maybe you can answer my question above.

[LisaDorn2024]

Yes, I am documenting as much as I can. I tried to print out the EPI log and it was too tiny and only a few days of the week. I am just using notebook paper, but it allows me to write more down. And since Levi is so sick I am home with him 24/7 and we are living in my kitchen and backyard only (due to the severity of his diarrhea.)

What I cannot understand it that I called the ICU several times a day to check on Levi and I would get a different story from each person and it always seemed to be a different staff member. I would ask if they had interacted with Levi and many times they would say "No, I am just reading the chart notes." There did not seem to be any consistency with people working with Levi other than the ICU doctor who only worked on M-Th. I was consistently told he was having stools rated 4's and 5's. I tried to bring him home once and he literally had liquid feces streaming from his bottom for 12 hours until I could drive him back and re-admit him. I was told this same thing the entire week before I brought him home this last time "all stools were rated 4 and 5." I cannot understand the discrepancy because I am following the treatment protocol exactly. I know I have a lot of personal stress from all of this and my own medical issues that have gone without treatment for the past 4 months so I could care for Levi, but I am doing my best to try and hide it from him.

[jilbert57]

That is interesting but frustrating. You would think that stress of being at the vet would cause a bad gut.
Was he on IV fluids at the vet?

Can you read on the package and tell me the strength of a Creon capsule?

Jill

[LisaDorn2024]

Tuesday afternoon Levi's ICU doctor terminated the Omeprazole from his treatment protocol because he has been declining since his discharge on Sunday. The vet told me omeprazole can increase GI symptoms in some dogs. He also told me the stomach rumbling and passing of foul smelling gas was not SID/SIBO/Dysbiosis, but I did not agree with him. Yesterday and today Levi has been extremely lethargic and today he has been sleeping almost the entire day and when awake he is actually yawning. I can tell by his eyes and facial expression he is definitely not feeling well. Yesterday was filled with numerous episodes of diarrhea, but overnight there was nothing. I added 1/2 tsp of slippery elm to his breakfast and he had a "relatively better" bowel movement with a stool probably rated as a 6 with maybe bits of a 5 mixed in, His stool is consistently yellow and smelly, very mushy but at least there was a bit of form to this one. It occurred about 10 minutes after eating breakfast. He has not have any other bowel movements today and he ate lunch 1.5 hours ago. This week he would have had 3-5 by now. I do not believe the slippery elm could work that fast, but I might be wrong. But even if it has controlled his diarrhea, he is in extreme discomfort. When he took a drink of water I noticed coughing and gagging afterwards. Could this be a sign that the Omeprazole needs to be added back? I did give him a compounded oral suspension of methylated B12 (1 ml) around noon, but it has not perked him up. If anything he is feeling worse since he ate lunch.
His canned food (Purina HA hydrolized protein is chicken based but it has pea starch in it.) I believe the pea protein may possibly causing Levi the GI discomfort as the foul smelling gas Levi passes smells very similar to the canned food, but not the dry kibble which does not have pea starch. During the months of his early puppyhood when he was eating vegetables , I would offer him a variety of veggies the color of the rainbow, The only vegetable he ever refused was peas. I think he knew his body did not like them. I brought the pea issue up to the ICU vet and he dismissed the idea. But i have read that many EPI dogs cannot digest peas.

3 Questions:
1. Does Slippery Elm work this fast? (one dose?)
2. Should the Omeprazole be added back to relieve the GI discomfort?
3. Could the pea starch be exacerbating Levi's SID/SIBO/Dysbiosis?

Thank you so much!

[Michaela]

Hi Lisa,

what is the strength of the Creon capsules Levi takes?

[LisaDorn2024]

He takes Creon 12
And he takes 2 capsules with each of his meals: breakfasts lunch, dinner.

[Eddiespaghetti]

Let me start by saying, yes slippery elm can be that fast. As soon as it's in their GI tract it is coating it. It is also a short acting one and why you have to give every day to keep it going.
I want to touch on some of the rarer issues that could be the cause.
Have you tried an immune suppressant to help with the allergies? Prednisone given at a high enough dose can give this effect, but there are others that do it better with less side effects. This isn't typically done because it's not a huge deal. Just stop giving what they are allergic too, but I feel it's not that simple for you and Levi.
Yes, the pea starch can be adding to the SIDs, but it is probably a better choice overall. You might be able to compensate for the peas by increasing the enzymes. Maybe do 2.25 or 2.5 tablets to see if that helps? Though it leads me to the next things. If he does have allergies and intolerances you might need to feed two times a day. You may also need to feed 4-5 times a day. It can go both ways. They might need less contact with the allergens, or there might be a threshold where they can tolerate X amount but anything over that tips the scales and tips it hard.

[LisaDorn2024]

Thank you, Eddie, for sharing some great information.

I have been giving Levi 1/2 tsp of slippery elm twice a day (breakfast and dinner.) I do feed him 3 times a day (he gets a lunch midday.) So would he need slippery elm at all 3 meals?

Levi has MANY allergies and most of them are protein sources so he is on a hydrolyzed protein diet right now, He is currently being transitioned from the Purina HA hydrolyzed protein (soy-based kibble) to the Ultamino hydrolyzed protein kibble. Olesia and Levi's regular veterinarian feel the Ultamino might work best for him right now with all of his allergies and sensitives. The pea protein is in his Purina HA hydrolyzed protein (chicken based) canned food. He gets 1 cup of dry food and 1 can at each meal with two Creon 12 capsules. I researched all of the canned hydrolyzed protein products made by Purina, Hills, and Royal Canin and all had pea protein. So until I can transition him to real whole food (hopefully, this will happen at some future time as I don't like him ingesting all of the additives and preservatives in these commercial hydrolyzed protein) I think Levi is stuck with pea protein.

One of his environmental allergies is to storage mites that live in kibble (all kibble.) I have noticed he is starting to be itchy and scratch and chew on himself. He was never fed kibble until he was hospitalized so it was never a problem. I am going to be doing some immunotherapy with him for the storage mites, but the poor little guy has so much going on I was hoping to wait until his GI system settle down a bit.

He had a really great day yesterday...best day in probably 2 months. He was so happy, alert, playing and following me everywhere. He had great stools after breakfast and lunch and another one in the very late afternoon. I did not hear any stomach rumbling nor was he passing any foul smelling gas. I could tell he was so happy to feel so good. However, after dinner things went downhill really fast and his last 2 bowel movements before going to bed were both 7's (liquid puddles.) He did not feel well after dinner and basically just laid around and slept at my feet. His stomach/abdomen area was bloated, his stomach was rumbling and he was passing the smelly gas. Nothing changed at his dinner meal. He eats the same thing for all 3 meals. The only thing I can think of is he played too much and was very active all day up until dinner, but I just don't know what went wrong.

Levi has been on 10 mg of prednisone b.i.d. for at least 2 months (probably more) so I am interested in your comment about other similar medications that don't have the side-effects. Please share the names of the medications so I can discuss them with Levi's veterinarian. His immune system is in over-drive right now and has been for many, many months. Since he had a bad gut when I adopted him at 8.5 months (although the breeder disagrees and tells me all of his littermates are happy and healthy and have had no issues at all) I believe his immune system has been hyper-reactive since then as well. His behavior has always been cyclical and corresponded to his days of diarrhea and days of constipation alternating between cranky and irritable to happy and playful. He was my puppy who never took naps even after 3 hours of playing at Doggie Daycare! He only slept 6 hours at most at night. I have always known there was something going on as his gut-brain connection was not typical of the other 10 golden retrievers I have had.

Thank you so much!

[Eddiespaghetti]

Leflunomide, mycophenalate moefitil, cyclosporine just to name a few. These are a lot stronger than your average prednisone in terms of immune suppressants. Most are also white label from humans. They might be too strong overall, but depending on how bad the allergies are it might work?
I know you said their weight for the slippery elm but I cannot remember it. With slippery elm, as it is a fibre, too much and it can trigger loose stools as well.
You can try giving the 1/2 teaspoon once a day and see if they have a blow out at the end of the day. It clearly helps you just need to find the right amount for Levi.
I was saying you could try to increase the enzymes. The Creon 12, by a quarter or a half tablet. It should help break down the pea starch IF it is a problem. Peas aren't super good for dogs even without EPI, but they are typically so refined and a small amount that it doesn't usually cause problems for most dogs. Whole peas and pea starch chemically are different.
You could also look into exotic meats, kangaroo, bison, koala? (Did I make that up?) I don't know if that was shown on the allergy test or not. The hydrolyzed food is the same chicken just without certain proteins that some dogs have problems with.
You two had a great day, which means you are on the right track it just needs some fine tuning. You are seeing the light. We are almost there.

[LisaDorn2024]

Thank you for the names of the medications. Olesia had mentioned Cyclosporine. I am going to run these past Levi's regular vet who will now be caring for him. We have tried to wean Levi off the prednisone a few times prior to his hospitalization before things got super bad, and every time we would decrease the dose even a tiny bit Levi would get sicker. But it might be time for a change.
Levi weighs approximately 55 lbs. Monday he will be weighed for the first time since his discharge and I am praying for a weight gain even if its only 1-2 lbs. He turns 10 months next week and he weighed 65 lbs 4 months ago when he was only 6 months old.
Since the Creon 12 is a capsule, is there a trick to divide it in half or quarters? I paid $500 for a bottle of 90 pills and I don't want to waste any. Since he now takes 6 pils a day, I will need to buy 2 bottles a month. I don't mind the expense if its what he needs and it works for him, but I don't want to waste any. I could kind of estimate when he was takin 1.5 at each meal but I always worried it wasn't exactly correct.
Good to know the pea starch is chemically different so it may not be a problem for Levi to digest. It is so interesting because Levi absolutely loves vegetables. I would cook several and let him pick which one he wanted first, second and last. He always picked broccolini first no matter what the other options were so I figured his body needed the nutrients in it the most. But the one vegetable he would sniff and walk away from was peas. I guess he knew they were not going to work for him.
I have ordered him a kangaroo bone, but for now I have not given it to him. Once he is doing consistently well I will surprise him with it. I have had to take away all of his treats, bones, bully sticks and things to chew on which makes life with a puppy very challenging. I feel so badly for him since he loved his bones. Glad we did a lot of training classes when he could still have treats!
I know pet stores sell rabbit, kangaroo an bison, but are you talking about feeding him the real meat from the animal? Where would I buy exotic meats - do they have them online that are from reputable sources? The pet store products are semi-processed at best and have a few other ingredients. He got sick from rabbit and bison, but I am not so sure he was really reacting to these protein sources. It may just be his was struggling to digest the protein. Going to do some food trials once he is doing much, much, much better.
So far Levi has had another good day. Just hope this evening does not take a nose dive like last night. Thank you for all of your help!