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Turbulent Tummies

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Aspen has blood coming out of her butt. I had just come out of a Starbucks about thirty-five minutes from home when my husband called to deliver this alarming news. Trying to remain calm, I told him that I would be there as quickly as possible and to have Aspen ready to go the emergency veterinarian hospital. It was Sunday, of course, and our regular vet was closed. The drive home seemed endless and I tried to avoid imagining worst case scenarios which proved to be a difficult task.

When I arrived home Aspen was no longer bleeding and seemed fine which slightly eased my worries. The hour-long drive to the hospital appeared to be a carefree ride in the car for Aspen as she showed no signs of being ill.

At the hospital Aspen was examined by a vet and a blood sample was taken. In a short amount of time our eighteen month old dog was diagnosed with hemorrhagic gastroenteritis.

Hemorrhagic gastroenteritis, also known as HGE, is an acute illness that can become life threatening in a short time if not treated immediately. The chief symptom of HGE is bloody diarrhea, ranging from bright red drops to a “raspberry jam” consistency. Dogs suffering from HGE may also exhibit vomiting, with or without blood, and lethargy.

Although HGE has been diagnosed in large dogs, it is more commonly seen in toy and small breed dogs. Veterinarians are not sure what causes this illness, but theories include bacterial infections, parasites, food allergies, and/or stress.

Fortunately, Aspen’s HGE was caught in a very early stage. Since that first episode, both Aspen and Malibu have had multiple bouts of HGE, with some cases being mild and others more serious. Several cases have required overnight hospitalization, but usually an IV fluid treatment and medication is all that is necessary. Metronidazole is prescribed and given for a week or two.

At some point in time, it was recommended that we change Aspen’s diet to Hill’s Prescription i/d.  This particular food is given to “promote gastrointestinal health”. A couple of years later, after another HGE episode, Aspen was switched to a different Hill’s formula. Believing that her HGE may be caused by a food allergy, Aspen’s vet prescribed z/d, which is hypoallergenic. We gave it a try even though I did not feel that the HGE was caused by Aspen’s diet. If the food Aspen was eating was causing the issue, she would have had symptoms more than a few times a year. Finally, we returned Aspen to her original diet, Wellness.

Despite the clinical symptoms of HGE lasting only a few days, a couple of Aspen’s bouts led to significant weight loss over the months following her illness. The reason for this is unknown.

The last HGE episode that required a visit to the vet for Aspen was about a year ago. The vet recommended that Aspen remain on the Metronidazole indefinitely, but I was not in agreement.

Seeking a second opinion I scheduled an appointment with a veterinarian gastroenterologist. The doctor provided me with additional information about HGE and stated that she does not consider it a disease, but rather a symptom of a disease.  Lab work was ordered to rule out Addison’s Disease and Maldigestion disorder. Test results were negative and Aspen was diagnosed with chronic, intermittent colitis. Like Aspen’s regular vet, the specialist  recommended that an antibiotic be given indefinitely.

Tylan was prescribed rather than Metronidazole with the goal of using the lowest dose needed to avoid symptoms.  In June of 2016 Aspen began taking two Tylan capsules a day. By December of that year she had been weaned to one capsule every third day. That did not last long because Aspen’s symptoms returned and the dosage was increased to one capsule a day. Last month I lowered the dosage to one capsule every other day.

I recently began giving my dogs probiotics with the hopes of preventing future episodes of HGE. Not everyone agrees that probiotics are worth the expense, but some tout the many benefits of giving them to our pets. “Boosting your dog’s immune system is probably the most important role of probiotics”, states Dogs Naturally Magazine. They add that, “A good balance of probiotics helps reduce inflammation throughout your dog’s body and that lowers their susceptibility to chronic disease.”

Although HGE can be a serious and life-threatening illness, I have been fortunate enough to identify its earliest symptoms in my dogs and seek treatment. Not knowing the exact cause of HGE is frustrating. Perhaps there are multiple causes, not just one. The important thing is treating it when it does happen.

Update – August 11, 2017

Quest, my Min Pin who has never required medical treatment for HGE, spent a few days in an animal emergency hospital last week. The diagnosis: hemorrhagic gastroenteritis. What began as gurgle guts and attempts at grass grazing on a Saturday morning transitioned to bloody diarrhea and vomiting in the predawn hours of Sunday. Off to the hospital we went. Initially, Quest was given fluids and sent home with Metronidazole, Panacur, and cans of Hill’s i/d.

By Sunday evening Quest was sicker, having episodes of bloody diarrhea every thirty minutes and exhibiting pain, so we returned to the hospital. Quest was admitted as we tried to figure out what caused her to get sick. She was sicker with HGE than my other two have ever been, and once again, we had no answers.

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Visiting Quest in the hospital

Fortunately, Quest appears to have completely recovered from this mysterious illness. She completed her medications earlier this week and has resumed her regular diet.

With Quest’s recent ordeal, I have more questions about HGE that will go unanswered. In addition, I now firmly believe that genetics plays a role in this illness. Aspen and Malibu have been dealing with HGE for years, but somehow Quest was able to avoid it until now. My husband and I often joke that Quest has a cast-iron stomach, but I guess we will not be saying that anymore because Quest just became a member of the HGE club.

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Aspen

Aspen

It has been just over a year since I brought my Min Pins to veterinary behaviorist, Dr. Karen Overall, for a consultation. The primary reason for our visit was Aspen’s aggressive behavior towards her littermate, Malibu. It had been going on for long enough and I was worried that it may lead to serious consequences.

Aspen was prescribed Fluoxetine, the generic form of Prozac.  After taking it for a few months with no change in behavior, I weaned Aspen off of the Fluoxetine. Dr. Overall suggested we try Trazodone, and I agreed. After a few weeks, I began to think that maybe the Fluoxetine had been working because Aspen’s aggression seemed worse. The Fluoxetine was started again and the Trazodone was continued.  In early winter, Aspen began exhibiting strange behavior upon awakening. She would wake up in a highly anxious state, shaking and appearing to be very frightened. I spoke with Dr. Overall and told her that I believed the Trazodone was causing this behavior. Aspen had never had this problem prior to taking the Trazodone. Aspen was weaned off of the Trazodone and has had no further occurrence of the odd behavior. Perhaps, it was caused by a combination of the Trazodone with the Fluoxetine. The Fluoxetine was continued for about two more months and then stopped because I observed no change in behavior.

Back at square one, I consulted again with Dr. Overall in late winter. Rather than try another medication, she thought a new food may help Aspen and recommended CALM. I was on board with the idea until I researched the manufacturer, Royal Canin. There were too many negative reviews and claims of pets getting sick while eating that brand of food. Dr. Overall had a second choice, Purina’s EN, if I was still willing to change Aspen’s diet. I admitted that I was apprehensive about introducing a new food to Aspen because of her history of HGE (hemorrhagic gastroenteritis).

Anxitane, a supplement that can be purchased over the counter, was the next suggestion. I was familiar with this product because it had been prescribed for Quest a couple of years earlier(with no success). Although Dr. Overall admitted that she didn’t have much confidence that Anxitane would be successful, she still felt that it was worth trying. Unfortunately, Aspen’s tummy did not tolerate the Anxitane, and it was discontinued after two tries.

Aspen is no longer taking any medications. She is still “growly” towards Malibu, but no worse than before. I had really hoped that a medication would “take the edge off” and help Aspen relax, but when it comes to medications, I have learned that I shouldn’t ever set my hopes on any improvement, let alone a miracle cure.

Dr. Overall recently stated that Aspen’s behavior may have neurodevelopmental origins. That is not to say that this is a hopeless case or that exploring other medications would be a futile process, but it definitely makes it more challenging. Finding a promising medication for a dog of Aspen’s size adds to the difficulty, noted Dr. Overall.

For now, I am choosing to keep Aspen free of medication. Fortunately, her issue is not so severe that it is deemed a dire situation by myself, or more importantly, Dr. Overall. I do not need to crate and rotate, use barriers, or any other forms of management to keep my dogs separated.  While Aspen and Malibu are not best buddies, they are able to be in the same room, on the same sofa, and remain civil more often than not. For that, I am very thankful.

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