Boxer IBD/food sensitivity + pancreatitis?

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Tue, 27 Mar 2018 09:04:13 GMT

[quote user="Michael Woodhouse"]In certain circumstances I will do a therapeutic trial with antibiotics, but never a fluoroquinolone. Why enrofloxacin?[/quote]

[quote user="robloxley"]Given the breed, suspicion of histiocytic ulcerative colitis of boxer dogs, and reports of resolution on enrofloxacin[/quote]

@Michael: what Rob says plus read the rest of the thread! It was against my better judgement and the original intent to refer was to investigate the possibility of Boxer Histiocytic Ulcerative Colitis but events overtook us. NDSR still consider pancreatitis to be the reason for the GI disease - cPL is still very high but that is on the back-burner for the moment. Dog has recovered and gone home albeit still weak.

RE: Boxer IBD/food sensitivity + pancreatitis?

Rob Loxley — Tue, 27 Mar 2018 08:39:15 GMT

[quote user="Michael Woodhouse"]In certain circumstances I will do a therapeutic trial with antibiotics, but never a fluoroquinolone. Why enrofloxacin?[/quote]

Given the breed, suspicion of histiocytic ulcerative colitis of boxer dogs, and reports of resolution on enrofloxacin?

RE: Boxer IBD/food sensitivity + pancreatitis?

Michael Woodhouse — Tue, 27 Mar 2018 00:33:36 GMT

[quote user="Martin Atkinson"]after a discussion with the owners on the limitations of a therapeutic trial he still declined to have intestinal biopsies and elected for a course of enrofloxacin against my better judgement.[/quote]

In certain circumstances I will do a therapeutic trial with antibiotics, but never a fluoroquinolone. Why enrofloxacin?

(I'd always used something like oxytet or metronidazole).

RE: Boxer IBD/food sensitivity + pancreatitis?

Anthony Dennison — Mon, 26 Mar 2018 17:12:41 GMT

[quote user="Martin Atkinson"]No.|There were no worm eggs identified on the faecal test.[/quote]

Sorry yes, you did say that!

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Mon, 26 Mar 2018 11:51:43 GMT

[quote user="Anthony Dennison"]

Interesting. Could it be there was a generally high worm burden anyway - not just lungworm but intestinal worms too?

[/quote]No.|There were no worm eggs identified on the faecal test. Lungworm can cause diarrhoea and vomiting but I've not seen in but the referral centre doesn't think they're connected as the GI signs had been going on so long. Every case of lungworm I've seen has presented with peripheral haemorrhage/petechia/echymosis, this was only picked up on the cranial MRI then a mild cough was mentioned in retrospect.

RE: Boxer IBD/food sensitivity + pancreatitis?

Anthony Dennison — Sat, 24 Mar 2018 09:38:50 GMT

Interesting. Could it be there was a generally high worm burden anyway - not just lungworm but intestinal worms too?

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Fri, 23 Mar 2018 16:17:14 GMT

For those who are still interested, after a discussion with the owners on the limitations of a therapeutic trial he still declined to have intestinal biopsies and elected for a course of enrofloxacin against my better judgement. After 2 weeks there was no improvement in the GI signs which were fluctuating as before but the general health of the dog started deteriorating rapidly with the later onset of severe neurological signs. The owner finally agreed to a referral and it was admitted to NDSR as an emergency this Tuesday. Meanwhile a faecal sample the locum had taken because he was suspicious of Giardia came back as positive only for Campylobactor.

An MRI of the brain showed an intracranial bleed which was suspected as due lungworm. The diagnosis was supported by a positive Angiotest and typical diffuse patchy lesions in the lungs. The dog is presently non-ambulatory and fighting for its life. Further tests showed mild pancreatitis but otherwise abdominal ultrasound was unremarkable. There is no suggestion that the chronic GI disease which had been going on for 3 months and the lungworm are related, indeed the faecal test did not show larvae, haematology I performed was unremarkable nor was there any evidence of lung lesions in a review of the X-rays I took a month ago but apparently he had developed a cough which I was not informed about before I went to Snowscene and came back this Monday.

It will be interesting, if the dog does survive, if the GI signs resolve having treated the lungworm - that would be a nice if unexpected resolution to the case and what significance the Campylobactor is.

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Mon, 26 Feb 2018 16:17:30 GMT

[quote user="robloxley"] "It is important to note histology has not been shown to help differentiate between the different disease categories and, therefore, in animals with low severity scores, biopsy should be reserved for patients that have failed appropriate therapeutic trials"[/quote]I agree when its IBD/dietary intolerance/allergy/'lower intestinal disease' but histiocytic ulcerative colitis is a disease with a distinct pathology on biopsy. The theory is that it is exacerbated by invasive E.coli species. If you throw enrofloxacin at it how do you know it didn't just treat some random bacterial infection/rearrange the gut flora but the underlying problem is still there and will recur?

RE: Boxer IBD/food sensitivity + pancreatitis?

Bob Russell — Mon, 26 Feb 2018 15:27:44 GMT

Throwing random antibiotics at an undiagnosed diarrhoea rarely works in my experience.

I do use certain antibacterial drugs at a certain stage where the clinical history and previous treatments suggest it is going to be of value diagnostically. I would generally do this long before any form of gut biopsy is carried out.

I do still use oxytet courses where laboratory results indicate bacterial overgrowth is a factor. I will use salazopyrin in some cases where diarrhoea is intractable and owners are unwilling/unable to investigate further.

Metronidazole is used if there is laboratory evidence to point to its use. With campylobacter this might be antibacterial and/or anti inflammatory action.

Any bug that the patient should be expected to clear on its own will be treated symptomatically.

We have a newish place that pushes raw diets and this is gathering pace so I make sure owners are aware of the risks associated with campylobacter in particular.

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Sat, 24 Feb 2018 09:45:42 GMT

[quote user="robloxley"]Slight tangent as your case maybe doesn't strike as classic ARD, but how do you make a diagnosis of antibiotic responsive diarrhoea? [/quote]If I suspect histiocytic ulcerative colitis I will diagnose it on biopsy and colonic culture; if it is what was known as ARD/SIBO, B12 and Folate levels should suggest this but IMO it is derangement of the normal gut flora secondary to a dietary intolerance so should clear if diet is addressed; diarrhoea caused by a genuine bacterial infection i.e salmonella, campylobactor will usually be self-limiting but if necessary I would choose the antibiotic based on faecal culture. The worst thing to do is throw random antibiotics at undiagnosed diarrhoea as it could lead to resistance. Even those which seem to respond to metronidazole probably do as a result of its immunomodulatory action.

RE: Boxer IBD/food sensitivity + pancreatitis?

Rob Loxley — Fri, 23 Feb 2018 18:24:05 GMT

[quote user="Martin Atkinson"]

[quote user="Bob Russell"]

Why not?

There are a number of antibiotic responsive intestinal problems.

I still use salazopyrine on occasions too.

[/quote]I prefer to make a diagnosis first.

[/quote]

Slight tangent as your case maybe doesn't strike as classic ARD, but how do you make a diagnosis of antibiotic responsive diarrhoea? There was a recent article on canine chronic enteropathies that said "It is important to note histology has not been shown to help differentiate between the different disease categories and, therefore, in animals with low severity scores, biopsy should be reserved for patients that have failed appropriate therapeutic trials"

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Fri, 23 Feb 2018 17:37:07 GMT

[quote user="Bob Russell"]

Why not?

There are a number of antibiotic responsive intestinal problems.

I still use salazopyrine on occasions too.

[/quote]I prefer to make a diagnosis first.

RE: Boxer IBD/food sensitivity + pancreatitis?

Edward Jones — Fri, 23 Feb 2018 16:10:17 GMT

There are three types of enteritis problems - steroid responsive, antibiotic responsive or dietary responsive (or a combination of all three).

RE: Boxer IBD/food sensitivity + pancreatitis?

Bob Russell — Fri, 23 Feb 2018 16:04:41 GMT

Why not?

There are a number of antibiotic responsive intestinal problems.

I still use salazopyrine on occasions too.

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Fri, 23 Feb 2018 14:04:35 GMT

[quote user="robloxley"]Do you never trial antibiotics?[/quote]No.

RE: Boxer IBD/food sensitivity + pancreatitis?

Rob Loxley — Fri, 23 Feb 2018 13:47:13 GMT

[quote user="Martin Atkinson"]Intestinal/colonic biopsies next if poor response to diet[/quote]

Do you never trial antibiotics?

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Fri, 23 Feb 2018 12:11:30 GMT

[quote user="robloxley"]histiocytic ulcerative colitis[/quote]Intestinal/colonic biopsies next if poor response to diet. Interestingly the O called this morning, dog was listless showing signs of abdominal discomfort overnight and came up with urticaria again but no vomiting or diarrhoea and appetite good after being given 2 Buscopan tablets.

RE: Boxer IBD/food sensitivity + pancreatitis?

Rob Loxley — Thu, 22 Feb 2018 18:53:40 GMT

[quote user="Richard Carter"]isn't there some e.coli that specifically affects boxers and the only treatment is an extended course of enrofloxacin?[/quote]

histiocytic ulcerative colitis

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Thu, 22 Feb 2018 18:52:51 GMT

[quote user="Richard Carter"]

isn't there some e.coli that specifically affects boxers and the only treatment is an extended course of enrofloxacin? Something rattling at the back of my brain

[/quote]Given this has been going on since December, the dog is fine for 1-2 weeks then gets an acute bout of vomiting with colic and diarrhoea for a couple of days then is OK for another 1-2 weeks it doesn't fit that picture but does with recurrent acute pancreatitis. I've never believed in bacterial overgrowth, it may happen but IMO its still due to poor digestive processes causing a change in bacterial flora. And B12 and Folate are low in this case.

RE: Boxer IBD/food sensitivity + pancreatitis?

Richard Carter — Thu, 22 Feb 2018 18:46:17 GMT

isn't there some e.coli that specifically affects boxers and the only treatment is an extended course of enrofloxacin? Something rattling at the back of my brain

RE: Boxer IBD/food sensitivity + pancreatitis?

Lindsey Edwards — Wed, 21 Feb 2018 17:04:33 GMT

I have found most hypoallergenic ranges to contribute to panceatitis due to higher than normal fat levels. My preferred option in such cases is royal canin gastro low fat (dry or wet) - seems to be digestible enough for sensitive dogs and low fat enough to prevent flares (RC hypo, even mod-calorie or hills z/d seem to trigger pancreatitis as do salmon/pork based ranges?)

RE: Boxer IBD/food sensitivity + pancreatitis?

Sean McCormack — Wed, 21 Feb 2018 15:45:13 GMT

Hi Martin,

We've met before in my previous, previous practice (AAU) but I'm now working a non-clinical role as tails.com vet. We provide diets and feeding programmes tailored to individual healthy dogs and those needing dietary support for minor complaints. But these complex cases with multiple dietary needs that are tricky to find an off the shelf solution for are often ones that we can cater for as well. We create bespoke diets for each dog, so should be able to cater for low fat pancreatitis needs and hypoallergenic at the same time.

If this client is interested, you can tell them to drop a line to hello@tails.com and explain the dog's multiple conditions, so a member of our vet/nutrition team can see what we can do.

Any other questions, just ask. And happy to give one month free codes to any vets on here that would like to try tails.com for their own dog.

Regards,

Sean

RE: Boxer IBD/food sensitivity + pancreatitis?

Bob Russell — Wed, 21 Feb 2018 15:23:07 GMT

Could do methylmalonic acid levels if you believe it is B12 deficient. Weekly B12 injections if so.

Sounds like this client may be a problem to get to do a food trial with.

There are some 'pork and potato diets that contain far more than pork and potato!

RE: Boxer IBD/food sensitivity + pancreatitis?

Martin Atkinson — Wed, 21 Feb 2018 14:00:23 GMT

[quote user="robloxley"]Supplement B12 - I usually go for injections but there is data on oral cobablamin[/quote]Funny you should mention it but I've just got some Protexin Cobalaflex capsules - and he's just wolfed half a can of RCW Gastro Low Fat.

RE: Boxer IBD/food sensitivity + pancreatitis?

Rob Loxley — Wed, 21 Feb 2018 13:53:07 GMT

[quote user="Martin Atkinson"]any other suggestions welcome[/quote]

Supplement B12 - I usually go for injections but there is data on oral cobablamin

If not improving on low fat diet maybe try hypoallergenic