Dawg Business: It's Your Dog's Health!: My Dog Has A Gut Of Steel, Doesn't He? Billy's Story (Part XI)

Tuesday, October 18, 2011

My Dog Has A Gut Of Steel, Doesn't He? Billy's Story (Part XI)

By Dr. Jonathan Mitelman and Barbara Kelly

Billy LOVES the beach, but hates the water

When we last left Billy, he had just torn apart a chew toy advertised as indestructible, leading him to more medical intervention.

Barbara: The timing of Billy eating this "indestructible" nylon grenade-shaped chew toy could never be good, but it coincided with a long booked, much needed, family vacation at a cottage up north.

Dr. Mitelman offered to take care of Billy, do the endoscopy, remove the object and let us have our time away.

I would never consider leaving Billy at a time like this.

Being a one-car family meant making three separate trips up north and back that week, and leaving my husband and son at the cottage while I tended to Billy's medical concerns.

Dr. Mitelman: Billy was back with us for a different sort of adventure. If it wasn't so stressful and ill-timed for Barbara, and moreover unbelievable, it would be comical.

The radiographs taken of Billy's abdomen not only confirmed the amount of plastic shards in his stomach, but their size as well.

Inducing vomiting to bring them back up would risk damaging his lower esophageal sphincter and the esophagus itself.

The preferred route was to feed him some Fiber Forte (a high-fibre powder) added to canned food and hope the plastic would be encased in a meatball that was physically more polite to Billy's innards, and we hoped they would pass without intervention.

When further plastic was vomited up, but nothing passed through, we decided our options were to intervene by performing an exploratory laparotomy (open up his belly and retrieve them) or remove them non-invasively using a flexible gastrointestinal endoscope.

We opted for the second choice, given Billy's stable condition.

Barbara: Billy needed to be fasted and purged for the endoscopy, so he was left at the clinic. I had several concerns.

First, that the foreign matter would become lodged, causing a blockage and necessitating emergency surgery.

Second was the anesthesia, always a risk in my mind, and he had already had an MRI requiring this just three months prior.

Dr. Mitelman: I assured Barbara of safe and up-to-date protocols, modern monitoring equipment, including blood pressure monitoring, capnography (monitoring the concentration or partial pressure of carbon dioxide in the respiratory gases), and of course our trained eyes.

During the procedure we were able to safely retrieve the foreign objects from Billy's stomach using specialized endoscopic graspers and transport bags.

But there was something else.

There appeared more chronic signs of abnormalities inside Billy's stomach. We also ventured beyond his stomach, beyond the muscular drain valve called the pylorus, and into his small intestine, where we found it too appeared abnormal.

Abnormal how?

The stomach appeared pitted and too pale, and the small intestine appeared too red. The inside lining appeared friable, in other words it tore off too easily.

The impression on the video screen is not a diagnostic. We called Barbara to ask permission to take biopsies, or tissue samples.

Barbara: When Dr. Mitelman called mid-procedure I was relieved that the pieces of the chew toy had been removed. But what came next shocked me.

My dog has a gut of steel, doesn't he?

He has never had any vomiting problems and the diarrhea was as a result of medication side effects. Or so we thought.

Could this explain what was causing Billy's pain?

Naturally I consented to the tissue samples being taken for biopsy.

Dr. Mitelman: Little droplet-sized pieces of intestinal, then stomach mucosa were collected in a non-invasive fashion, as a part of a full GI scope. We performed a colorectal scope as well.

Not only did we retrieve some more plastic pieces (that would likely have found their way out, with some discomfort, mind you), we also harvested more tissue biopsies.

Could gut pain manifest with pacing, licking and his other behavioral changes? You bet it can.

Barbara: Billy was discharged later the same day. This is commonplace as the endoscopy is minimally invasive, and doesn't cause pain. I decided to take him up north, to the beach he loved, and join our family to wait for the biopsy results.

When Dr. Mitelman called two days later, the results of the tests left me both relieved and concerned. The good news was there was no cancer.

The diagnosis: inflammatory bowel disease.

Dr. Mitelman: The pathology results revealed considerable inflammation throughout Billy's gut, from top to bottom. The amazing thing, though, is that Billy was already on anti-inflammatory medication (steroids and cyclosporine) for awhile before these samples were harvested.

So, if the fire was still burning, does that mean it was raging before the medications were introduced?

Or that the medications were not effective enough for Billy's condition. Or both? Or neither?

Inflammatory bowel disease is a complex disorder that can't accurately be described in a few sentences. It is primarily the result of:

Loss of equilibrium in the interaction between the proteins in the ingested food moving down the gut and the populations of bacterial flora inhabiting the gut
The cellular make-up in the absorptive tissue in the inner lining of the gut itself

This affects the interactions between digestive organs and physical pipelines, blood vessels, hormones, immune system and nerves that connect them all.

There is still a lot we don't know about IBD.

Barbara: Now we had a diagnosis of Billy's IBD we knew we had to get things under control. Our challenge was to deal with this, his ongoing skin issues and the suspected connection between the conditions, and of course his adverse side effects/reactions to medications that would normally be prescribed for both.

Dr. Mitelman and I embarked on yet another search to find some much needed relief for Billy.

***

The Kingston Road Animal Hospital, and its founder Dr. Morris Samson, are celebrating the clinic's 25th anniversary this year. VETSToronto, the veterinary emergency trauma service, is housed in this location in the Beach area of Toronto.

The hospital is a full service emergency/after hours/critical care facility that provides around the clock care. There is a doctor on site 24/7/365. Owners Dr. Samson and Dr. Mitelman oversee all cases, providing continuity of care.

Referrals from other hospitals are examined, stabilized and treated, then returned to their regular clinic. Follow ups are done with both the referring veterinarians and the pet's owners.

As a full service hospital we have the following:

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call

Tuesday, October 18, 2011

My Dog Has A Gut Of Steel, Doesn't He? Billy's Story (Part XI)

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